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

Vasiliki Tsarpali; Karsten Midtvedt; Kjersti Lønning; Tomm Bernklev; Nanna von der Lippe; Anna Varberg Reisæter; Cathrine Brunborg; Kristian Heldal

doi:10.1016/j.xkme.2021.05.007

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

Kidney Med. 2021 Jul 22;3(6):974-983.e1. doi: 10.1016/j.xkme.2021.05.007. eCollection 2021 Nov-Dec.

Authors

Vasiliki Tsarpali^{1

2}, Karsten Midtvedt³, Kjersti Lønning³, Tomm Bernklev^{2

4}, Nanna von der Lippe^{2

5}, Anna Varberg Reisæter³, Cathrine Brunborg⁶, Kristian Heldal^{1

3}

Affiliations

¹ Clinic of Internal Medicine, Telemark Hospital Trust, Skien, Norway.
² Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
³ Department of Transplantation Medicine, Section of Nephrology, Oslo University Hospital, Oslo, Norway.
⁴ Department of Research and Innovation, Vestfold Hospital Trust, Tønsberg, Oslo University Hospital, Oslo, Norway.
⁵ Department of Medicine, Section of Nephrology, Oslo University Hospital, Oslo, Norway.
⁶ Oslo Center for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway.

Abstract

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.

Keywords: HRQoL; Health-related quality of life; comorbidity score; dialysis; elderly; kidney transplantation; outcomes; predictors.