BACKGROUND: Although the prognosis of kidney transplantation is generally good, long-term survival varies substantially between patients. This study examined whether health-related quality of life (HRQOL) predicts long-term mortality in kidney transplantation after adjustment for known risk factors. METHODS: A cohort of 347 (46.77 ± 13.96 years) kidney transplant recipients was followed up for 12 years after enrolment (1999-2001). Patients completed measures of HRQOL and medical records were reviewed to document clinical and cardiovascular risk factors and comorbidities at study entry (mean [SD], 8.57 [6.55] years after transplantation). The primary outcomes were ensuing all-cause mortality and all-cause graft failure (a composite endpoint consisting of return to dialysis therapy, preemptive retransplantation, or death with function). Cox proportional hazards multivariate models were developed to identify predictors of long-term patient and graft survival. RESULTS: During the 12-year follow-up, 86 (24.8%) patients died, 64 (18.3%) died with a functioning graft, and 35 (11.1%) were placed back to dialysis. Physical QOL impairment increased the risk of mortality and graft failure during the follow-up period. The risk remained significant after adjusting for sociodemographic and clinical risk factors (adjusted hazard ratio, 1.89; 95% confidence interval, 1.09-2.95; P=0.022 and adjusted hazard ratio, 1.68; 95% confidence interval, 1.12-2.52; P=0.012 for patient and graft survival, respectively). Other significant risk factors were older age, time elapsed since transplantation, and Charlson comorbidity index. Risk of graft failure was also associated with glomerular filtration rate. CONCLUSIONS: Physical HRQOL predicts long-term mortality and graft failure independently of sociodemographic and clinical risk factors in renal transplant patients. Future research should identify the determinants of HRQOL and refine interventions to improve it.
BACKGROUND: Although the prognosis of kidney transplantation is generally good, long-term survival varies substantially between patients. This study examined whether health-related quality of life (HRQOL) predicts long-term mortality in kidney transplantation after adjustment for known risk factors. METHODS: A cohort of 347 (46.77 ± 13.96 years) kidney transplant recipients was followed up for 12 years after enrolment (1999-2001). Patients completed measures of HRQOL and medical records were reviewed to document clinical and cardiovascular risk factors and comorbidities at study entry (mean [SD], 8.57 [6.55] years after transplantation). The primary outcomes were ensuing all-cause mortality and all-cause graft failure (a composite endpoint consisting of return to dialysis therapy, preemptive retransplantation, or death with function). Cox proportional hazards multivariate models were developed to identify predictors of long-term patient and graft survival. RESULTS: During the 12-year follow-up, 86 (24.8%) patients died, 64 (18.3%) died with a functioning graft, and 35 (11.1%) were placed back to dialysis. Physical QOL impairment increased the risk of mortality and graft failure during the follow-up period. The risk remained significant after adjusting for sociodemographic and clinical risk factors (adjusted hazard ratio, 1.89; 95% confidence interval, 1.09-2.95; P=0.022 and adjusted hazard ratio, 1.68; 95% confidence interval, 1.12-2.52; P=0.012 for patient and graft survival, respectively). Other significant risk factors were older age, time elapsed since transplantation, and Charlson comorbidity index. Risk of graft failure was also associated with glomerular filtration rate. CONCLUSIONS: Physical HRQOL predicts long-term mortality and graft failure independently of sociodemographic and clinical risk factors in renal transplant patients. Future research should identify the determinants of HRQOL and refine interventions to improve it.
Authors: Elizabeth A King; Mary Grace Bowring; Allan B Massie; Lauren M Kucirka; Mara A McAdams-DeMarco; Fawaz Al-Ammary; Niraj M Desai; Dorry L Segev Journal: Transplantation Date: 2017-10 Impact factor: 4.939
Authors: Mara A McAdams-DeMarco; Israel O Olorundare; Hao Ying; Fatima Warsame; Christine E Haugen; Rasheeda Hall; Jacqueline M Garonzik-Wang; Niraj M Desai; Jeremy D Walston; Silas P Norman; Dorry L Segev Journal: Transplantation Date: 2018-02 Impact factor: 4.939
Authors: Claire Juliet Martin; Elmi Muller; Demetre Labadarios; Frederick Johannes Veldman; Susanna Maria Kassier Journal: Qual Life Res Date: 2021-06-22 Impact factor: 4.147
Authors: Yiman Wang; Jaapjan D Snoep; Marc H Hemmelder; Koen E A van der Bogt; Willem Jan W Bos; Paul J M van der Boog; Friedo W Dekker; Aiko P J de Vries; Yvette Meuleman Journal: Clin Kidney J Date: 2021-01-20
Authors: Heather J MacKinnon; Thomas J Wilkinson; Amy L Clarke; Douglas W Gould; Thomas F O'Sullivan; Soteris Xenophontos; Emma L Watson; Sally J Singh; Alice C Smith Journal: Ther Adv Chronic Dis Date: 2018-07-04 Impact factor: 5.091