Health-related quality of life and symptom experience in tacrolimus-based regimens after renal transplantation: a multicentre study

Abstract

Tacrolimus is increasingly used as a baseline immunosuppressant after renal transplantation. This multicentre study assessed healthrelated quality of life and symptom experience in renal transplant patients on tacrolimus-based therapy, using the SF-36 and Euroqol 5 dimensions (EQ-SD) and the 'modified transplant symptom occurrence and symptom distress scale', respectively. Symptoms of depression were assessed with the short form of the Beck Depression Inventory and physical activity with the Baecke questionnaire. Overall, 350 patients with a median post-transplant status of 16.7 months were enrolled. Results revealed that patients experienced lower SF-36 scores than the general population, except in terms of bodily pain. Univariate and multivariate analyses demonstrated that a higher degree of depressive symptoms and female gender were consistently related to a health status perceived as being worse and a higher rate of symptom experience. These findings are in accordance with previous quality-of-life reports that assessed patients under various immunosuppressive therapies. Therefore, interventions, including the screening and treatment for depression and the addressing of gender-specific issues, can enhance quality of life.

Symptom experience after solid organ transplantation

“…To date, the majority of research on symptom experiences has focused on the assessment of symptoms due to specific immunosuppressive drugs, for example, hirsutism predominantly caused by cyclosporine A [13,15,23,24]. Although this approach has advanced our knowledge of specific drug-related symptoms, the next necessary step within this context is the development of strategies for symptom management which need to be tested in randomized clinical trials.…”

“…Secondly, there are other symptoms as experienced by the individual such as increased hair growth, trembling hands, fatigue, or lack of concentration. These symptom experiences may directly or indirectly influence other important outcomes that affects patients' overall well-being and quality of life [13,15,24,[31][32][33] and activities of daily living [20] and subsequently influences patients' motivation to comply to the therapeutic regimen [14,15,32,34]. Clinical experience and empirical data suggest that transplant patients may attempt suicide with increasing symptom experiences [35].…”

“…Therefore, instruments have been developed focusing on patients' self-report of experienced immunosuppression-related symptom occurrence and symptom distress [13][14][15]17,21,22]. Instruments that are described in the literature measure side-effects of immunosuppressive drugs [13][14][15][23][24][25][26][27][28] but may also cover disease or comorbidity-related symptoms [14,29].…”

“…As part of the therapeutic regimen, immunosuppressive agents and other medications used are associated with a variety of drug-related symptoms [12,13,15,[21][22][23][24][25]. There are two major foci on drug-related symptoms: the first is based on the biomedical model [30] and evaluates those adverse effects which may increase mortality and comorbidities like hypertension, osteoporosis, diabetes, and cancer in the long-term after transplantation [1,2,9].…”

Are There Sex Differences in Health-Related Quality of Life After Lung Transplantation for Chronic Obstructive Pulmonary Disease?

“…10,16,18 Collectively, these findings highlight the need to more fully examine the symptom profile of women and men separately, both before and after lung transplantation. If there is a gender-specific symptom profile, as suggested by the findings in this study, then educational presentations and materials can be adapted to reflect the shared and unique symptom experiences of men and women.…”