Abstract
With the improvements in short and long term graft and patient survival after renal transplantation over the last two decades Health-Related Quality of Life (HRQL) is becoming an important additional outcome parameter. Global and disease specific instruments are available to evaluate objective and subjective QOL. Among the most popular global tools is the SF-36, examples of disease specific instruments are the Kidney Transplant Questionnaire (KTQ), the Kidney Disease Questionnaire (KDQ) and the Kidney Disease-Quality of Life (KDQOL). It is generally accepted that HRQL improves dramatically after successful renal transplantation compared to patients maintained on dialysis treatment but listed for a transplant. It is less clear however which immunosuppressive regimen confers the best QOL. Only few studies compared the different regimens in terms of QOL outcomes. Although limited in number, these studies seem to favour non-cyclosporine based protocols. The main differences that could be observed between patients on cyclosporine versus tacrolimus or sirolimus therapy concern the domains of appearance and fatigue. This may be explained by two common adverse effects occurring under cyclosporine therapy, gingival hyperplasia and hair growth. Another more frequently occurring side effect under calcineurin inhibitor therapy is tremor, which may favour CNI free protocols. This hypothesis, however, has not been formally evaluated in a randomised trial using HRQL measurements.In summary HRQL is becoming more of an issue after renal transplantation. Whether a specific immunosuppressive protocol is superior to others in terms of HRQL remains to be determined.
Highlights
Health-related quality of life (HRQL) contains multiple aspects of health related issues from the patients' perspective including physical, psychological, and social functioning and overall well-being [1,2,3]
Generic tools are useful for comparisons among groups and studies and for evaluating the impact of different diseases on QOL. These tools are used in HRQL research and include tests such as the Sickness Impact Profile (SIP), the 36-item short-form of Medical Outcomes Survey (SF-36), and the Nottingham Health Profile (NHP)
The same authors recently published a longitudinal relationship between adverse effects particular of immunosuppressive drugs in renal transplant recipients and QOL [9]
Summary
Health-related quality of life (HRQL) contains multiple aspects of health related issues from the patients' perspective including physical, psychological, and social functioning and overall well-being [1,2,3]. HRQL was evaluated only in a limited number of clinical trials as subjective state of health [6,7,8,9,10,11,12,13,14,15] It is generally accepted that patients with a functioning renal allograft have an improved HRQL as compared to patients on dialysis [14,16]. These tools are used in HRQL research and include tests such as the Sickness Impact Profile (SIP), the 36-item short-form of Medical Outcomes Survey (SF-36), and the Nottingham Health Profile (NHP). The same authors recently published a longitudinal relationship between adverse effects particular of immunosuppressive drugs in renal transplant recipients and QOL [9] In this huge study 4247 self-selected patients were enrolled and assessed by a QOL questionnaire. Shield reported that one year after transplantation, the study population score in vitality was in the 50th percentile of an age matched general US population
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