Trends and predictors of multidimensional health-related quality of life after living donor kidney transplantation
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Trends and predictors of multidimensional health‑related quality of life after living donor kidney transplantation John D. Peipert1,2 · Juan Carlos Caicedo2 · John J. Friedewald2 · Michael M. I. Abecassis2 · David Cella1,2 · Daniela P. Ladner1,2 · Zeeshan Butt1,2,3 Accepted: 1 April 2020 © Springer Nature Switzerland AG 2020
Abstract Purpose Living donor kidney transplant (LDKT) imparts the best graft and patient survival for most end-stage kidney disease (ESKD) patients. Yet, there remains variation in post-LDKT health-related quality of life (HRQOL). Improved understanding of post-LDKT HRQOL can help identify patients for interventions to maximize the benefit of LDKT. Methods For 477 LDKT recipients transplanted between 11/2007 and 08/2016, we assessed physical, mental, social, and kidney-targeted HRQOL pre-LDKT, as well as 3 and 12 months post-operatively using the SF-36, Kidney Disease Quality of Life—Short Form (KDQOL-SF), and the Functional Assessment of Cancer Therapy—Kidney Symptom Index 19 item version (FKSI-19). We then examined trajectories of each HRQOL domain using latent growth curve models (LGCMs). We also examined associations between decline in HRQOL from 3 months to 12 months post-LDKT and death censored graft failure (DCGF) using Cox regression. Results Large magnitude effects (d > 0.80) were observed from pre- to post-LDKT change on the SF-36 Vitality scale (d = 0.81) and the KDQOL-SF Burden of Kidney Disease (d = 1.05). Older age and smaller pre- to post-LDKT decreases in serum creatinine were associated with smaller improvements on many HRQOL scales across all domains in LGCMs. Higher DCGF rates were associated with worse physical [e.g., SF-36 P CSoblique hazard ratio (HR) 1.18; 95% CI 1.01–1.38], mental (KDQOL-SF Cognitive Function HR 1.27; 95% CI 1.00–1.62), and kidney-targeted (FKSI-19 HR: 1.18; 95% CI 1.00–1.38) HRQOL domains. Conclusion Clinical HRQOL monitoring may help identify patients who are most likely to have failing grafts and who would benefit from post-LDKT intervention. Keywords Health-related quality of life · Kidney transplant · Living donor · Survival
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11136-020-02498-2) contains supplementary material, which is available to authorized users. * John D. Peipert [email protected] 1
Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 625 Michigan Ave, 21st Floor, Chicago, IL 60611, USA
2
Northwestern University Transplant Outcomes Research Collaborative, Comprehensive Transplant Center, Feinberg School of Medicine, Chicago, IL, USA
3
Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
Abbreviations BMI Body mass index BUN Blood urea nitrogen CFI Comparative fit index DCGF Death-censored graft failure DDKT Deceased donor kidney transplant ESKD End-stage kidney disease FKSI-19 Functional Assessment of Cancer Therapy—Kidney Symptom Inde
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