Changes in quality of life and working capacity before and after kidney transplantation

Abstract

KIDNEY transplantation (KT) has evolved as a successful therapy for patients struggling with end-stage renal disease. Advances in surgical and medical protocols have resulted in the excellent survival rates. 1,2 Debates regarding the quality of life (QOL) of dialysis and transplant recipient groups have been ongoing for about two decades. 3‐11 Although most studies show that QOL is one of the most important benefits of KT, 3,7‐24 some researchers still argue that KT does not significantly improve QOL over dialysis. 4‐6 The health-related QOL of KT recipients is a complex phenomenon. Recipients’ assessment of QOL often reflects their adaptation to their postdischarge, posttransplant lives. During the predischarge stage, most Taiwanese KT recipients are anxious about the quality of medical care, their self-efficacy, and related social support. Alleviating the anxiety of KT recipients with regard to these issues may be critical in determining their recovery and QOL after discharge. 25 However, few researchers have prospectively monitored the monthly changes in the selfrated QOL of KT recipients during the first postdischarge year. Instead, the QOL is often examined from a crosssectional view, according to the time frame of standard posttransplant evaluation visits; these evaluations tend to center around the medium- or long-term survivors. 4 ‐ 6,8 ‐18 Working capacity (WC) as well as income are important indicators of self-assessed QOL among Taiwanese KT recipients. 2 However, the challenge of transplantation to a recipient’s postoperative economic status, and the relationship between recipients’ QOL and WC during the first posttransplant year have not been carefully investigated. The purpose of this study was to examine the trend of changes in the QOL and WC after KT, from the preoperative stage to 1 year after discharge from the hospital after KT. PATIENTS AND METHODOLOGY A descriptive, prospective design was used to explore the trends in QOL and WC perceived by KT recipients before and after surgery. The inclusion criteria were as follows: (1) at least 18 years old; (2) clear consciousness; (3) no transplant surgeries other than KT; and (4) prepared to be discharged from National Taiwan University Hospital the next day. The first interview was conducted 1 day before the patient’s discharge from the hospital, and follow-up interviews were conducted 1, 2, 3, 6, and 12 months after discharge from the hospital during outpatient, posttransplant visits. The patient profile was used to collect information about the patient’s demographic information, medical history, medications that the subjects had taken in the floor unit, postoperative complications, and the length of floor unit stay. The subjects were asked to rate their perceptions of QOL and WC on separate visual analog scales (VASs). The VAS used in this study was a 100-millimeter (mm) vertical line. This line was anchored at the bottom with the words “Worst quality of life” or “Unable to work,” and at the top by “Optimal quality of life” or “Optimal working capacity,” respectively. During the first interview, the participants were also asked to rate their perceptions of overall preoperative QOL and WC on VASs, based on their 24 hours preoperatively.