Health-Related Quality of Life in Older Kidney Transplant Recipients: A National Cohort Study of Short- and Longer-Term OutcomesPlain-Language Summary

• Published in: Kidney medicine 2021-11, Vol.3 (6), p.974-983.e1
• Main Authors: Vasiliki Tsarpali, Karsten Midtvedt, Kjersti Lønning, Tomm Bernklev, Nanna von der Lippe, Anna Varberg Reisæter, Cathrine Brunborg, Kristian Heldal
• Format: Article
• Language: English
• Subjects: comorbidity score; dialysis; elderly; Health-related quality of life; HRQoL; kidney transplantation
• ISSN: 2590-0595; 2590-0595

Rationale & Objective: Assessing the optimal therapy for older patients (aged ≥65 years) with end-stage kidney disease requires knowledge of longevity and health-related quality of life (HRQoL) outcomes. Kidney transplantation prolongs survival but its long-term impact on HRQoL in older recipients is not well defined. We aimed to prospectively evaluate HRQoL changes from enlisting until 3 years posttransplantation and examine pretransplantation predictors of posttransplantation outcomes. Study Design: Prospective cohort study. Setting & Participants: Patients 65 years and older enlisted at the Norwegian National Transplant Center between January 2013 and November 2016. Predictors: Kidney transplantation, dialysis vintage, and pretransplantation comorbidity assessed using the Liu Comorbidity Index. Outcomes: HRQoL, assessed using the Kidney Disease Quality of Life Short Form, version 1.3. Analytical Approach: HRQoL scores obtained at 3 years posttransplantation were compared with those obtained pretransplantation and after 1 year using a paired-sample t test. Multivariable linear mixed-effect models were used to identify possible predictors of HRQoL changes over time. Results: Among 289 patients included, 220 (mean age, 71.5 years) had undergone transplantation and 136 had completed the 3-year HRQoL follow-up by October 2020. Posttransplant HRQoL, both generic and kidney specific, substantially improved and the benefit persisted for 3 years. For wait-listed candidates remaining on dialysis, HRQoL gradually deteriorated, and recipients who died within 3 years posttransplantation experienced no improvement during the first year. Moderately elevated pretransplantation comorbidity scores and prolonged dialysis vintage independently predicted poor HRQoL outcomes posttransplantation. Recipients receiving dialysis for 1 year or longer with pretransplantation comorbidity scores ≥ 7 experienced a marked and sustained physical deterioration after transplantation. Limitations: Homogenous and highly selected population. Conclusions: Transplantation is associated with a sustained HRQoL improvement and should be the preferred treatment for selected older patients. The value of a pretransplant comorbidity score to predict posttransplantation outcomes warrants further evaluation and may improve the selection process.