Health-related quality of life, treatment adherence, symptom experience and depression in adolescent renal transplant patients

Abstract

Few studies comprehensively assessed psychological and behavioral functioning in adolescent kidney transplant patients. The purpose of this cross-sectional study was to evaluate depression, QOL, treatment adherence and presence of side effects from the perspective of the patient and his parents, and to compare scores with norm data. All patients (age 10-18 yr) and their parents completed the following instruments: KIDSCREEN-27 (QOL), a treatment adherence interview, the MTSOSD-59R (side effects) and the Beck Depression Inventory (depression). Twenty-three of 26 patients and 22 parents agreed to participate (70% male; median age 15 yr). Adolescents rated their QOL as satisfactory, but parents reported significant problems on several QOL dimensions. Depressive symptoms occurred in 17.4%, and 75% were non-adherent with their immunosuppressive drugs (confirmed by their parents) and show other problematic health behavior, including smoking, illicit drug use, dietary non-adherence, and suboptimal exercise levels. The most frequently occurring side effects were increased appetite, fatigue and headache; the most distressing ones were hair loss or thinning of hair, warts on hands or feet, and sores in the mouth or on the lips. Our results underscore the need for regular screening and adequate treatment of the above-mentioned aspects.

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“…1,9,32 Our search for studies investigating the depression level in liver transplant patients after transplant demonstrated a gap in the literature. On the other hand, a study of kidney transplant patients demonstrated no depression in 82.6% of the patients, 7 which is similar to the rate (88%) determined in this present study. That there was no difference between the depression level of the case group patients and that of their healthy peers is a positive outcome.…”

“…In a study of adolescent kidney transplant patients (median age, 15 y), the most prevalent symptoms were increased appetite, fatigue, headache, pimples, trembling hands, increased thirst, lack of energy, mood swings, flatulence, and warts on the hands or feet. 7 That these symptoms were different from the symptoms observed in our patients can be explained by the use of different immunosuppressants in the liver transplant. In our study, the patients experienced all the psychological symptoms included in the MTSOSD-58.…”

“…7,9,10 The questionnaire included 6 questions: (adherence/ nonadherence), smoking (yes/no; the number of cigarettes a day), illicit drug use (yes/no; frequency), alcohol consumption (yes/no; amount; frequency), dietary adherence (5 answering categories ranging from never following my diet, to following it every day), and exercise adherence (5 answering categories ranging from never to daily).…”

“…6 Medication nonadherence is reported to be the most important cause of graft loss in adolescent transplant patients. 2,7,8 In their meta-analysis, Dew and associates 9 investigated medical regimen adherence in pediatric organ transplant patients (0-18 y) and reported that studies generally crosssectional. They also reported that of the 18 studies investigating liver transplant recipients' (LTR) compliance, only 1 was conducted in Asia, 3 in Europe, and the other 14 in the United States.…”

Side Effects of Immunosuppressive Regimens After Renal Transplantation and Multiple-Sample Assessment of Quality of Life

“…Total score of each part was similarly obtained by adding those of the individual items, and a larger score referred to more distresses of side effects. If the occurring frequency of a specific side effect of a patient was reported as "not at all" (0 point), the corresponding symptom distress would not be included in the statistical analysis as the missing data [11,12].…”