Patient reported outcomes following renal transplantation: the future of holistic post-transplant care
Harry VM Spiers1,2, Sharon Frame3, Rosie R Heape3,4, Kieron K Clark3, Arcan A Altinar4, Linda Ross3, Hayley Wells3, Anna Simpson4, Joe Chilcot4, Lyndsay Hughes4, Dominic M Summers1,2, John Weinman4, Matthew Hotopf4, Antonia A Cronin3,4.
1Department of Transplantation, Addenbrooke's Hospital, Cambridge, United Kingdom; 2Department of Surgery, University of Cambridge, Cambridge, United Kingdom; 3Department of Nephrology and Transplantation, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; 4Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
Introduction: Patients with renal disease prioritise symptoms and functionality over the biochemistry and clinical guidelines, which clinicians traditionally rely on. Whilst kidney transplantation is expected to offer better survival and quality of life than dialysis, many recipients suffer limitations in their daily lives, due to factors associated with transplantation, such as immunosuppression side effects and infection. This study aimed to assess patient reported outcomes after kidney transplantation, to improve understanding and facilitate enhanced holistic post-transplant care.
Methods: A retrospective analysis of a prospectively maintained database of patients completing PHQ-9 and GAD-7 questionnaires, each consecutive year following renal transplantation, was conducted between 2013 and 2020 at a single institution.
Results: 698 patients returned PHQ-9 and GAD-7 questionnaires during the time period. After excluding incomplete records, 599 patients were included in the final analysis. There was a male preponderance (81.0%), and median age of 54 (range 19-84). The median number of consecutive completed annual questionnaires per patient was 3 (range 1-8). The majority of patients (70.1%) scored no depression on PHQ-9, followed by 18.5% reporting mild depression, with 11.3% falling into moderate to severe categories. Mean score at last assessment was worse than at first assessment (4.0 vs 2.6, p<0.001), but remained within the ‘no depression’ category. With GAD-7, 83.1% of patients scored minimal anxiety, followed by 9.6% reporting mild anxiety, with the remaining 7.1% scoring moderate or severe anxiety. Mean score at last assessment was worse than at first assessment (2.9 vs 1.9, p<0.001), but remained within the ‘minimal anxiety’ range.
Discussion: Most patients undergoing renal transplantation do not suffer from depression or anxiety post-operatively, however, a significant proportion experience moderate to severe depression and anxiety. Prospective studies understanding the causes, and links with routinely collected biochemical data, will enable clinicians to identify and support at risk patients, delivering holistic evidenced based care.
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