Impact of Immunosuppressant Therapies and Transplantation on Health-related Quality of Life Among Renal Transplant Recipients at Kenyatta National Hospital

Abstract

Background: The prevalence of renal transplantation has recently been shown to increase globally. To prevent graft rejection and loss, renal transplant recipients are required to take immunosuppressive drugs for a prolonged period of time. Limited studies exist on the impact of immunosuppressive agents and transplantation on health related quality of life outcomes among renal transplant recipients in resource constrained settings. Study objective: To determine the impact of immunosuppressive agents and transplantation on health related quality of life outcomes in renal transplant recipients at Kenyatta National Hospital (KNH). Study area and setting: The study was conducted at the renal transplant clinic, within renal unit of KNH. Methodology: A cross-sectional descriptive study involving 80 patients who were consecutively sampled was carried out between 1st July 2021 and 30th September 2021. Patients’ socio-demographics, the type of immunosuppressive medication regimen, side effects, and adherence data were collected using a predesigned data collection tool. Assessment of health related quality of life was done using the kidney transplant questionnaire-25 (KTQ-25), a validated tool that has been used worldwide. Data analysis was carried out using Stata version 13 statistical software at P < 0.05. Categorical variables such as side effects of drugs were summarized as frequencies while continuous variables like participants’ age were expressed using measures of central tendencies. Associations between immunosuppressant regimen type, side effects, adherence and sociodemographic variables with HRQoL score were determined using ANOVA. Linear regression analysis was conducted to determine independent predictors of low HRQoL scores. Results: The mean (SD) age of the participants was 45.4(14.7) with a male predominance (70%). Hypertension was the most prevalent comorbidity among study participants (60%) followed by both diabetes and hypertension (25%). The most prevalent immunosuppressant regimen was prednisolone, tacrolimus, and mycophenolate (75%) and the adherence rate was 78.8%. Weight gain (33.8 %) was the commonest side effect experienced, followed by fatigue (27.5%) and diarrhea (23. 8%). The mean(SD) HRQoLwas 5.19(0.78), denoting good health related quality of life among the study participants. The highest score of the KTQ was in the appearance dimension 6.62(0.60) while the lowest was on uncertainty/fear domain 4.28(1.12). Variables that were significantly associated with low HRQoL were comorbidity (p=0.017) and immunosuppressant side effects of changes in appearance (p=0.002) and physical symptoms (p=0.011) domains. Immunosuppressant regimen and adherence to antirejection medication were not significantly associated with HRQoL. Having diabetes decreased the score of HRQoL by 11.67 units {95% CI (-21.283, -2.064)}. Conclusions: Generally, HRQoL of kidney transplant patients was good. However, uncertainty and fear was the least scored domain in quality of life assessment reflecting fear and stress among kidney transplant patients. Side effects from immunosuppressant medication had an influence on the appearance and physical symptoms dimensions of health related quality of life. Immunosuppressant medication non-adherence rate was 21.2% which was attributed to unaffordability of immunosuppressant medication. Recommendations: Blood sugar levels should routinely be monitored among renal transplant recipients to continue improving on the management. Future studies should correlate mean scores of quality of life domains before and after transplantation to ascertain the impact of transplantation on HRQoL to improve the management of renal transplant recipients.