Systematic reviewQuality of life after kidney and pancreas transplantation: a review
Section snippets
Psychosocial assessment of patients for kidney transplantation
Kahan8 recently summarized selection criteria for transplantation as follows: “accepted notion of benefit” (medical need, life remaining, and posttransplantation QOL), “patient's rights” (based on the right of every patient to transplantation if they so wish), “cost-effectiveness” (on the basis of best economic outcome), and “scientific progress” (whether the patient's treatment will advance medical science). These concepts are designed to assist the physician in allocating scarce resources of
QOL in relationship to medical compliance
Psychosocial issues and compliance are discussed increasingly in relation to QOL. Traditionally, compliance behavior has been considered in terms of the physician's ability to influence the patient and the patient's willingness to respond. However, in an attempt to move away from connotations of the all-powerful physician and the powerless patient, there was a move to replace the term compliance with that of adherence and, more recently, concordance. Adherence and concordance play to the
QOL in relation to psychosocial well-being
Skotzko et al17 performed a survey to determine the views of the transplant community on psychosocial issues. They found overwhelming support for providing psychosocial support both pretransplantation and posttransplantation to increase patient rehabilitation. There also was broad support for substance abuse treatment programs for recipients of organ transplants; most respondents also acknowledged the impact of psychosocial factors on compliance, QOL, and survival. Respondents to this survey
Review of the literature
There are numerous studies examining QOL after kidney and pancreas transplantation. We searched MEDLINE, the Cochrane Library, EMBASE, Cinahl, PsycINFO, ASSIA, RCN journals, SERFILE 202, and World Information Nursing and the World Wide Web using the terms “quality of life and kidney transplants” and “quality of life and pancreas transplants.” Only articles in English were included. Priority was given to articles that were prospective and randomized and used controls and articles after 1995. We
Critique of the literature
The studies we reviewed used a variety of questionnaires; selection of a QOL instrument was dependent on the bias of the investigators, making it difficult to compare studies across centers. The majority of studies are retrospective and there are wide differences in cultural patterns, sample sizes, and durations of follow-up. Another problem with self-reported studies is the poor response from patients. None of the studies reported the effect of self-reported questionnaires on the patient's
Patient empowerment
There is an increasing trend to involve patients directly in treatment planning, which, in turn, may lead to increased compliance. However, there has been little legislative support for this position. Empowerment does not come about by some miraculous process of osmosis, but through the acquisition of communicative and behavioral competence on the part of both the staff and patient—skills that may be lacking in patients from lower socioeconomic groups, who might easily be overwhelmed by the
5-year prediction
An important issue is availability of organs. Griva et al20 from University College, London, UK, compared health-related QOL in 76 living related and 271 cadaveric organ recipients, looking at social, medical, and psychological improvements after transplantation. They observed improved emotional well-being in all patients. However, living related transplant recipients expressed greater levels of feeling guilt, probably because they continue to see the donors. In another such study from Japan,
Conclusion
We propose that all recipients of organ transplants be routinely assessed for QOL by means of the SF-36 or a disease-specific instrument; for compliance, by means of the LTMBS Scale; and for psychological status, by means of the BDI, BSI, or SCL-90-R (Table 5). Adequate funding should be provided for the additional expense in implementing a program of assessment and intervention in appropriate cases. Over time, we may be able to construct a universal instrument that will capture these 3
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Cited by (64)
Long-Term Functional Recovery, Quality of Life, and Pregnancy After Solid Organ Transplantation
2016, Medical Clinics of North AmericaCitation Excerpt :The inability to pursue their original line of work, such as manual labor, can be a major factor for unemployment.14 Appropriate use of vocational training can increase the rate of return to the work force for transplant recipients.15 HR-QOL is defined as an individual’s self-assessment of their health and encompasses physical status, mental health, and social well-being.
Mortality on the kidney waiting list and after transplantation in patients with peripheral arterial disease: An analysis of the United States Renal Data System
2016, Transplantation ProceedingsCitation Excerpt :These findings may be due to a higher rate of severe arterial disease in DD recipients, with implications for patient selection and education prior to transplantation. Although data specifically in patients with PAD who undergo transplantation is lacking, quality of life is known to improve after renal transplantation in patients with end-stage renal disease [9,26,27]. We did not see a survival benefit in patients with PAD, especially those with amputation who underwent DD transplantation, however, the positive impact of improved quality of life after transplantation should be considered in the selection process of potential recipients.
High rate of unemployment after kidney transplantation: Analysis of the united network for organ sharing database
2014, Transplantation ProceedingsCost Utility of Sirolimus versus Tacrolimus for the Primary Prevention of Graft Rejection in Renal Transplant Recipients in Mexico
2012, Value in Health Regional IssuesCitation Excerpt :Approximately 25,000 patients currently receive chronic dialysis, with the majority receiving continuous ambulatory peritoneal dialysis [4]. Renal transplantation is the treatment of choice for ESRD because, if successful, the quality and duration of life is better than that achieved with long-term dialysis [5–9]. ESRD has not only clinical consequences but also economic implications.
Health-related quality of life and clinical outcomes in kidney transplant recipients
2011, American Journal of Kidney DiseasesCitation Excerpt :Moreover, depression is an important predictor of quality of life and mortality in kidney transplant recipients.3,46 Feelings of hopelessness and worthlessness, difficulties with concentration and memory, and loss of interest in daily activities may result in treatment nonadherence behaviors that include forgetting to take pills or missing regular follow-up appointments.59-61 Depression also may result in loss of appetite and malnutrition.62
Modern indications for referral for kidney and pancreas transplantation
2023, Current Opinion in Nephrology and Hypertension