Clinical Factors Influencing Participation in Society after Successful Kidney Transplantation

Abstract

Clinical factors influencing participation in society after successful kidney transplantation van der Mei, S.F.; Groothoff, J.W.; van Sonderen, E.L.P.; van den Heuvel, W.J.A.; de Jong, P.E.; van Son, W.J. Background. Little information is available on the degree of actual social functioning after successful kidney transplantation. Moreover, information on factors that influence participation in social activities is scarce. The aim of this study was to examine the influence of clinical factors on social outcome. Methods. A retrospective study was performed on a cohort of primary kidney transplantation patients, transplanted between 1996 and 2001. Cross-sectional data on participation in obligatory activities (i.e. employment, education, household tasks), leisure activities (i.e. volunteer work, assisting others, sports, clubs/associations, recreation, socializing, going out) and change in participation were collected by in-home interviews (nϭ239). Multivariate regression analysis was performed.Results. Thirty-six percent of the patients scored low on obligatory participation and only 52.4% was employed.Patients were actively involved in a wide range of leisure activities. Twenty-six percent participated in sports. Multivariate analysis (age-, sex-, and education-adjusted) of participation in obligatory activities showed negative associations with advanced age (PϽ0.01), comorbidity (previous cardiovascular events; PϽ0.01) and cadaveric transplantation (PϽ0.01). There was a positive association with time since transplantation (PϽ0.01). Multivariate analysis of diversity of participation in leisure activities and perceived change in participation after transplantation showed no statistically significant associations with clinical factors. Conclusions.Besides age, clinical factors such as type of donation (cadaveric versus living), comorbidity (previous cardiovascular events), and time since transplantation were associated with participation in obligatory activities such as employment, education and household tasks. Diversity of leisure activities and change in participation was not affected by clinical factors.

Factors Determining Social Participation in the First Year After Kidney Transplantation: A Prospective Study

“…Clearly, longer convalescence time is needed. Despite the increase in time spent on active employment, the number of recipients with a paid job hardly changed (T1, 54%; T2, 56%), and is comparable to the employment rate (52%) we found in Dutch kidney transplant recipients with a mean follow-up of 3.8 years (14). The fact that in our study 47% (nϭ14) of employed recipients received additional social security benefits due to work disability, suggests that it is unrealistic to expect a further increase in employment rate.…”

“…Data on health status, transplantation-related symptoms and psychological characteristics were collected by standardized self-report questionnaires, sent to participants preceding the interview. Methodology of data collection is described in detail elsewhere (12,14).…”

“…Comorbidity was defined as diabetes mellitus (insulin or oral antidiabetic drugs dependent), and presence of cardiovascular disease evidenced by a history of cardiovascular events (14). Additional clinical characteristics: type of transplantation (cadaveric vs. living); type (peritoneal vs. hemodialysis) and duration (years) of dialysis prior to transplantation; allograft rejection (biopsy proven); duration of initial hospitalization (days); followup hospitalization at the UMCG; renal allograft function (24-hour urinary creatinine clearance); type of triple immunosuppressive therapy (Table 1); body mass index (BMI).…”

“…Worse social outcome was also found in adults treated with kidney transplantation in childhood (13). Factors contributing to this impaired social participation are not widely studied yet, although worse social outcome has been reported for cadaveric donation as compared to living donation, and for patients with cardiovascular disease (14). Posttransplantation return to work was associated with employment status pretransplantation (15)(16)(17).…”

The role of disparities and socioeconomic factors in access to kidney transplantation and its outcome

“…Employment rates after solid organ transplantation have been reported as low as 45-55% [42][43][44][45][46] driven by poor health, acute rejection episodes, and fear of loss of health insurance or disability benefits. 42,45,47 On the other hand, transplant recipients who worked prior to transplantation and have higher pre-transplant incomes and levels of education, as well as those without diabetes and receiving the kidney from the living donor are more likely to return to work.…”