Changes in quality of life, health status and other patient-reported outcomes following simultaneous pancreas and kidney transplantation (SPKT): a quantitative and qualitative analysis within a UK-wide programme.

Andrea Gibbons,Christopher J E Watson,Charles R V Tomson,Gabriel C Oniscu,Wendy Metcalfe,John Forsythe,Clare Bradley,J Andrew Bradley,Marco Cinnirella,Janet Bayfield,Rommel Ravanan,Rachel J Johnson,Heather Draper,Chris Dudley

doi:10.1111/tri.13677

Abstract

We examined quality of life (QoL) and other patient-reported outcome measures (PROMs) in 95 simultaneous pancreas and kidney transplant (SPKT) recipients and 41 patients wait-listed for SPKT recruited to the UK Access to Transplantation and Transplant Outcome Measures (ATTOM) programme. Wait-listed patients transplanted within 12months of recruitment (n=22) were followed 12months post-transplant and compared with those still wait-listed (n=19) to examine pre- to post-transplant changes. Qualitative interviews with ten SPKT recipients 12months post-transplant were analysed thematically. Cross-sectional analyses showed several better 12-month outcomes for SPKT recipients compared with those still wait-listed, a trend to better health utilities but no difference in diabetes-specific QoL or diabetes treatment satisfaction. Pre- to post-transplant, SPKT recipients showed improved treatment satisfaction, well-being, self-reported health, generic QoL and less negative impact on renal-specific QoL (ps<0.05). Health utility values were better overall in transplant recipients and neither these nor diabetes-specific QoL changed significantly in either group. Pre-emptive transplant advantages seen in 12-month cross-sectional analyses disappeared when controlling for baseline values. Qualitative findings indicated diabetes complications, self-imposed blood glucose monitoring and dietary restrictions continued to impact QoL negatively post-transplant. Unrealistic expectations of SPKT caused some disappointment. Measuring condition-specific PROMs over time will help in demonstrating the benefits and limitations of SPKT.

Highlights

Simultaneous pancreas–kidney transplantation (SPKT) is generally considered the optimum treatment for selected patients with insulin-dependent diabetes and stage G5 chronic kidney disease (CKD) [1,2,3,4]
There were no significant differences between responders and nonresponders in sex, ethnicity, employment status, civil status, education, renal replacement therapy (RRT), type of donor (donation after brainstem death (DBD) or donation after circulatory death (DCD)), recruitment patient-reported outcome measures (PROMs) or utility measures
The negative impact of participants’ renal conditions on quality of life (QoL) reduced following transplantation, but surprisingly, the negative impact of diabetes on QoL showed no such improvement. This finding can be explained in part by the qualitative findings, which show that participants reported positive changes, their QoL continued to be impaired by long-standing diabetes-related complications

Summary

Introduction

Simultaneous pancreas–kidney transplantation (SPKT) is generally considered the optimum treatment for selected patients with insulin-dependent diabetes and stage G5 chronic kidney disease (CKD) [1,2,3,4]. Generic health status measures such as the Short Form SF-36 [10] and the EQ-5D [11,12] have shown that SPKT recipients report comparable outcomes to kidney-alone transplant recipients [13,14,15]. A small number of studies have compared SPKT recipients with those still awaiting transplant and reported that SPKT recipients have better scores on the SF-36 [14,15,16]. These studies, are cross-sectional and do not include genuine measures of QoL, so they cannot tell us how QoL may be impacted by SPKT. SPKT recipients reported better outcomes, but no pretransplant data were provided, so any differences may have been present pretransplant and not caused by the transplant

Methods

Results

Conclusion