Health-related quality of life and employment among renal transplant recipients

Chisholm‐Burns MA, Erickson SR, Spivey CA, Kaplan B. Health‐related quality of life and employment among renal transplant recipients.
Clin Transplant 2011 DOI: 10.1111/j.1399‐0012.2011.01541.x.
© 2011 John Wiley & Sons A/S. Abstract: Objective: To examine the relationship between health‐related quality of life (HQoL) and employment status in renal transplant recipients (RTRs). Methods: Eighty‐two RTRs met inclusion criteria: 21–65 yr of age; greater than one yr post‐transplant; and received calcineurin inhibitors. A cross‐sectional survey was conducted using a demographics questionnaire and the following HQoL instruments: SF‐12 Health Survey version 2 (Physical Component Summary [PCS‐12] and Mental Component Summary [MCS‐12]) and Kidney Transplant Questionnaire (KTQ). Two multivariate logistic regression analyses (SF‐12 model and KTQ model) were conducted to determine whether HQoL and demographic variables were independently associated with employment status. Results: Seventy‐five RTRs were included in the analysis. Compared with employed RTRs, a greater number of unemployed RTRs were non‐white, had lower education levels, and had deceased donor transplants (p < 0.05). Employed RTRs had significantly higher SF‐12 scores (p < 0.05). In the SF‐12 logistic regression model, PCS‐12 and education level were significant predictors of employment status (p < 0.05). In the KTQ model, the Fatigue subscale and education level were significant predictors of employment status (p < 0.05). Conclusions: Findings suggest higher PCS‐12, higher KTQ‐Fatigue, and education level are independently associated with employment status. Interventions targeted to improve HQoL, decrease fatigue, and increase education level are discussed.     

Analysis of clinical variables of donors and recipients with respect to short-term graft outcome in human liver transplantation

Donor and recipient factors are closely associated with graft survival after orthotopic liver transplantation (OLT). This study was performed to analyze clinical characteristics of recipients and donors, which affect 30-day graft loss after OLT. MATERIALS AND METHODS: One hundred eighty-six livers from heart-beating donors were accepted between May 1997 and June 1998 at the University of Pittsburgh Medical Center. Donor variables that were analyzed included age, sex, cold ischemia time (CIT), warm ischemia time (WIT), imported versus local procurement, cardiopulmonary arrest, serum sodium level, and dopamine dose. The recipient characteristics included native liver disease and UNOS status. Two-sided Fisher exact test and stepwise logistic regression were used for univariate and multivariate analyses. P-values < .05 were considered statistically significant. RESULTS: Twenty-eight grafts (15.1%) were lost within 30 days of OLT. The following factors were found to adversely affect graft survival: donor sodium > 155 mEq/L (P = .002); CIT > 12 hours (P = .002); WIT > 45 minutes (P = .002); and imported liver graft (P = .048). Logistic regression revealed that donor sodium (odds ratio, 3.03; 95% CI, 1.05 to 8.74), CIT (OR 1.20; 95% CI 1.05 to 1.38), WIT (OR 1.06; 95% CI 1.01 to 1.09) were independent predictors of early graft loss. CONCLUSION: Donor hypernatremia as well as warm and cold ischemia times independently affect graft outcomes in the early postoperative period after OLT. Avoidance of long preservation and correction of donor sodium level are recommended to optimize results and survival in OLT.     

Relationship between sleep problems and health-related quality of life among pediatric liver transplant recipients

Among adult liver transplant recipients (LTRs), sleep disturbances and fatigue are common. Sleep problems following pediatric liver transplantation may contribute to daytime fatigue and lower health-related quality of life (HRQOL). The aim of this cross-sectional study was to determine the impact of sleep problems on the HRQOL of pediatric LTRs using validated measures. Participants included 47 LTRs. Mean age of the LTRs was 10.9 ± 4.6 years, and mean time since transplantation was 6.2 ± 3.9 years. The primary indication for transplantation was biliary atresia (51%). According to parent reports, pediatric transplant recipients had symptoms of sleep-disordered breathing, excessive daytime sleepiness, daytime behavior problems, and restless legs; 40.4% of parents and 43.8% of children reported significantly lower total HRQOL for the recipients. Age, time since transplantation, and health status were not significantly related to the quality of life. Hierarchical regression analyses revealed that the sleep-disordered breathing subscale of the Pediatric Sleep Questionnaire accounted for significant variance in parent-proxy reports on the Pediatric Quality of Life (PedsQL) summary scales measuring children's psychosocial health (R(2) = 0.36, P < 0.001), physical health (R(2) = 0.19, P = 0.004), and total HRQOL (R(2) = 0.35, P < 0.001). Also, the sleep-disordered breathing subscale accounted for significant variance in the child self-reported school functioning scale (R(2) = 0.18, P = 0.03). Clinically significant sleep problems were more common among children with low total HRQOL. In conclusion, sleep problems were common in this cohort of pediatric LTRs and predicted significant variance in HRQOL. Prospective larger scale studies are needed to assess factors that contribute to sleep difficulties and low HRQOL in this population. The detection and treatment of significant sleep problems may benefit the HRQOL of pediatric LTRs.     

Sleep disorders and quality of life in renal transplant recipients

Kidney transplantation provides the best outcome for patients with end-stage renal failure both in terms of morbidity and mortality and health-related quality of life (QoL). Health-related QoL has become recognized as an important outcome measure in patients with different chronic medical conditions, including chronic kidney disease (CKD). There are several factors in kidney-transplanted patients which have a negative impact on QoL in these patients. Sleep disorders, such as insomnia, sleep apnea syndrome (SAS), and restless legs syndrome (RLS), are common in kidney-transplanted patients and clearly belong to this group of factors, although there is only limited published data available about the association between sleep problems and QoL in this patient population. The prevalence of both insomnia and RLS is reduced in kidney-transplanted patients compared to dialysis patients, and it is similar to the prevalence observed in the general population. The prevalence of sleep apnea, however, is very high, around 30%. The association between the presence of these sleep disorders and impaired QoL has been relatively well documented in dialysis patients, but there is only scarce published information about this association in the kidney transplant population. In this paper, we will summarize data from the literature describing the impact of sleep problems, which are potentially treatable, on QoL in kidney-transplanted patients. We suggest that the appropriate diagnosis and management of sleep disorders may improve QoL in kidney-transplanted patients.     

Pain affects health-related quality of life in kidney transplant recipients

BACKGROUND: Chronic pain is prevalent in end-stage renal disease patients undergoing chronic hemodialysis. We do not fully know the intensity of chronic pain experienced by kidney recipients in comparison to those on chronic hemodialysis and healthy controls. Moreover, the effect of chronic pain on kidney recipients' health-related quality of life (HRQoL) is yet to be comprehensively addressed. We designed this study to find an answer to these questions. METHODS: In this case control study, we studied 205 kidney recipients, 69 hemodialysis patients, and 100 healthy controls, who were matched for age, sex, monthly family income, and educational level. The patients were evaluated for the intensity of chronic pain by Visual Analogue Scale (VAS). HRQoL was measured with Short Form 36 (SF-36) in the kidney recipients. Chronic pain intensity was compared in the study groups, and in the kidney recipients the correlation between SF-36 subscores and severity of pain was assessed. RESULTS: Severity of pain in the kidney recipients was lower than the hemodialysis patients, but more than the healthy controls (P=.001). The VAS pain score negatively correlated with the scores of SF- 36 total (r=-.329, P=01), mental health (r=-.190, P=07), physical health (r=-.275, P=.001), physical function (r=-.339, P=.001), role limitation due to physical problems (r=-.478, P=.001), role limitation due to emotional problems (r=-.326, P=.001), and bodily pain (r=-.894, P=.001). DISCUSSION: The intensity of chronic pain experienced by the kidney recipients is less than that experienced by patients under chronic hemodialysis, but higher than healthy subjects. Focusing on chronic pain as a cause of post-renal transplantation morbidity is expected to improve post-renal transplantation quality of life.     

Employment and quality of life in liver transplant recipients.

The purposes of liver transplantation (LT) include the extension of survival, improvement in quality of life, and the return of the recipient as a contributing member of society. Employment is one measure of the ability to return to society. The aim of this study is to determine the factors affecting employment/subemployment after LT. A total of 308 adult liver transplant recipients who were seen at the University of California, Los Angeles were administered the Medical Outcomes Short Form 36 (SF-36) and a questionnaire regarding work history and insurance coverage. Multivariate analysis were used to identify independent variables associated with posttransplantation employment. Interaction terms were used to examine effect modification. Of 308 transplant recipients, 218 (70.8%) worked prior to transplantation, and 78 (27%) worked posttransplantation. Pretransplant variables that were independently associated with posttransplantation employment included the following: lack of disability income (odds ratio [OR] = 1.86; 95% confidence interval [CI], 1.32-7.18; P = 0.36); health maintenance organization (HMO)/preferred provider organization (PPO) insurance (OR = 3.08; 95% CI, 1.32-7.18; P < 0.01); the number of hours worked (OR = 1.17; 95% CI, 1.08-1.28; P < 0.01); and the lack of diabetes mellitus (OR = 0.23; 95% CI, 0.70-0.73; P < 0.01). An interaction term between disability income and hours worked prior to transplantation (OR = 0.16; 95 % CI, 0.03-0.83; P = 0.03) was independently associated with posttransplantation employment. In a separate regression model of SF-36 responses, posttransplantation physical functioning (OR = 1.17; 95% CI, 1.10-1.26; P < 0.01) and role-physical (OR = 1.1; 95% CI, 1.02-1.16; P < 0.01) were independently associated with employment after transplantation. In conclusion, HMO or PPO insurance, lack of disability income coverage prior to transplant, the absence of diabetes mellitus, the number of hours worked prior to transplantation, and high physical functioning were associated with posttransplantation employment.     

肺移植患者生活质量现状及影响因素研究

目的调查肺移植术后患者的生活质量现状及其影响因素,为制订改善肺移植患者生活质量方案提供参考。方法采用一般资料问卷和SF-36量表,对217例肺移植术后门诊随访患者进行横断面调查。结果肺移植患者的生理功能、生理职能、躯体疼痛、总体健康、社会功能、情感职能维度得分显著低于国内常模(均P0.01);躯体方面生活质量的影响因素为照顾者、是否发生血液系统并发症和腹泻天数;心理方面生活质量的影响因素为是否发生血液系统并发症和工作状态(均P0.05)。结论肺移植术后患者生活质量较低,术后生活质量受多因素的影响,应重点关注患者移植后并发症的发生情况,做好针对性护理。     

Health-related quality of life among renal-transplant recipients in Japan

BACKGROUND: This study had four goals: (1) to evaluate an index of health-related quality of life (HQOL) among renal-transplant recipients in Japan, (2) to compare HQOL of renal-transplant recipients with that of the Japanese population as a whole, and (3,4) to study associations of HQOL with renal function and with the time since transplantation. METHODS: Questionnaires were distributed to 570 subjects. All were outpatients, were 16 years old or older, and were studied at least 1 year after they had received their latest renal transplant. HQOL was assessed with the Short Form 36-item health survey. Subjects' physicians provided data on renal function. Associations of HQOL with serum creatinine concentration and with the time since transplantation were evaluated by logistic regression. RESULTS: The response rate was 83%. Data from patients with diabetes and from those who had had at least two renal transplants were excluded; data from 395 recipients were analyzed. On the physical functioning, general health perception, vitality, and social functioning scales, the patients' scores were significantly lower than the Japanese national-norm scores. General health perception was particularly low. Serum creatinine concentrations were associated with general health perception, vitality, and social functioning. Longer times since transplantation were associated with better social functioning. CONCLUSIONS: Although social and physical functioning may improve after transplant surgery, a low self-rating of general health seemed to remain. The rarity of renal transplantation in Japan and other psychosocial factors may explain the low self-rating of general health in Japanese renal-transplant recipients.     

Gene network profiling before and after transplantation in alcoholic cirrhosis liver transplant recipients

The main objective of this study was to define a gene network profile network in liver transplant recipients with alcoholic cirrhosis before and after liver transplantation. Genes were selected from data obtained in a previous study of liver transplant recipients with alcoholic cirrhosis. Selected up-regulated genes were further validated by quantitative real-time polymerase chain reaction in different groups of liver transplant recipients with alcoholic cirrhosis (n=5). Selected genes up-regulated before transplantation were: TNFRSF9 (tumor necrosis factor [TNF] receptor superfamily, member 9); IL2RB (interleukin-2 receptor beta); BCL2L2 (BCL2-like 2); NOX5 (NADPH) oxidase, EF-hand calcium binding domain 5); PEX5 (peroxisomal biogenesis factor 5); PPARG (peroxisome proliferator-activated receptor gamma); NIBP (IKK2 binding protein); NKIRAS2 (NFKappaBeta inhibitor interacting Ras-like 2); IL4 (interleukin-4); IL-4R (interleukin 4 receptor); ADH1A (alcohol dehydrogenase 1A, class 1); ALDH1L1 (aldehyde dehydrogenase 1 family, member L1); MPO (myeloperoxidase); NPPA (natriuretic peptide precursor A); BCL2A1 (BCL2-related protein A1); GADD45A (growth arrest and DNA-damage-inducible alpha); TEGT (Bax inhibitor 1); PIK3CA (phosphoinositide-3-kinase, catalytic, alpha polypeptide); IFNGR2 (interferon gamma receptor 2); JAK2 (Janus Kinase 2); FAS (Fas, TNF receptor superfamily, member 6); TANK (TRAF family member-associated NFKB activator); TTRAP (TRAF and TNF receptor-associated protein); and ANXA5 (annexin A5).     

An exploratory investigation of quality of life in adult liver transplant recipients

Quality of life is an important outcome indicator of experiences associated with liver transplantation. Unfortunately, quality of life has been defined in many different ways, causing confusion and misconceptions among practitioners, researchers, policy makers, and patients. This exploratory qualitative study was initiated to gain greater understanding regarding the adult transplant recipients' experiences with liver transplantation in order to direct future studies with this population and to assist in selection of a relevant quality of life survey tool for quantitative investigation. Twelve informants (7 women, 5 men) shared their experiences in face-to-face interviews conducted by the researcher. Analysis of these interviews reveals the importance of physiologic, psychological, social, spiritual, family, and socioeconomic aspects of quality of life for liver transplant recipients.     

The quality of life in adult survivors of allogeneic bone marrow transplantation. Correlates and comparison with matched renal transplant recipients

Research on the quality of life (QOL) following bone marrow transplantation has been hampered by assessment of a limited range of QOL domains as well as by a failure to assess relevant comparison groups. The QOL of adult survivors (n=29) of allogeneic BMT (mean of 51 months post-BMT) drawn from two BMT centers was assessed. QOL was also assessed in a sample of renal transplantation (RT) patients (n=29) matched with BMT patients with regard to age, sex, and time since transplant. Results indicated few differences between the BMT and RT groups across a broad range of QOL domains. Overall, neither group reported what might be considered a "normal" QOL. Multivariate analysis of the correlates of post-BMT QOL revealed that (1) less education, increased dosage of total-body irradiation during pre-BMT conditioning, and an older age at BMT were all associated with poorer status on several measures of post-BMT QOL; (2) time post-BMT was unrelated to post-BMT QOL; and (3) post-BMT affective status was more difficult to predict than post-BMT health or functional status. It was concluded that, while results indicate an acceptable post-BMT QOL, further research is necessary to identify means by which post-BMT QOL can be improved.     

Life situation and quality of life in young adult kidney transplant recipients

Background. Young adults, 18–35 years of age, may be morevulnerable to chronic diseases than other age groups. In thisstudy we describe the life situation and lifestyle of youngadult kidney transplant recipients and compare their health-relatedquality of life (HRQoL) with a general population sample. Methods. Questionnaires, including items on life situation,lifestyle, and the SF-36 HRQoL questionnaire, were mailed toall 280 renal transplant recipients in Norway between 18 to35 years of age at the time of investigation of whom 131 (47%)responded. For comparison, we used 2,360 respondents aged 18to 35 years from a general population survey in one Norwegiancounty. SF-36 scores are presented with unadjusted scores andthe mean difference between groups adjusted for age, sex andeducation using multiple linear regression analysis. Results. The kidney transplant recipients reported high participationrates in cultural and sports activities, and the majority ofthem were satisfied with their work. A larger proportion ofthe transplant recipients had attained university educationthan the general population sample. However, 25% of the totalgroup were not integrated in professional life. The transplantrecipients scored lower than the general population on sevenof the eight SF-36 scales and the two summary scales after adjustingfor age, sex and education. Conclusions. The majority of young adult kidney recipients aged18–35 years were well adapted in their family and professionallife and satisfied with their current life situation. However,in aggregate they reported lower HRQoL on most scales of theSF-36 than a general population sample.     

Increased prevalence of gastrointestinal symptoms associated with impaired quality of life in renal transplant recipients

BACKGROUND: Immunosuppressive therapies have been associated with gastrointestinal (GI) side effects, which may impair health-related quality of life (HRQoL). METHODS: In this survey, 4,232 renal transplant recipients from Denmark, Finland, Norway, and Sweden completed the Short-Form 36 (SF-36) questionnaire and the Gastrointestinal Symptom Rating Scale (GSRS). SF-36 scores were compared with country norm values. Multiple logistic regression analysis was used to identify immunosuppressants associated with GI symptoms. RESULTS: The prevalence of troublesome GI symptoms (GSRS>1) was 83% for indigestion, 69% for abdominal pain, 58% for constipation, 53% for diarrhea, 47% for reflux, and 92% for any GI symptom. Compared with the general population, HRQoL was most commonly meaningfully impaired in the general health dimension (53% of patients). The presence and severity of GI symptoms were associated with worse HRQoL. Tacrolimus showed a significant association with diarrhea (odds ratio [OR]: 1.7; 95% confidence interval [CI]: 1.4-2.0) and constipation (OR: 1.3; 95% CI: 1.1-1.6), and sirolimus with indigestion (OR: 2.9; 95% CI: 1.0-8.1) and abdominal pain (OR: 2.2; 95% CI: 1.1-4.4). CONCLUSIONS: GI symptoms are associated with impaired HRQoL in the renal transplant population. Managing GI symptoms by careful choice of immunosuppressants should be a focus for improving HRQoL in renal transplant recipients.     

重视肝移植受者的长期生活质量

随着肝移植手术技术和围手术期处理的日趋成熟以及新型免疫抑制药物的研发,移植术后长期生存率亦逐渐提高,因此如何加强和规范肝移植病人术后的中、长期管理,关注和提高他们的生活质量是我们面临的又一挑战,需关注以下几个方面.