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  • An overall sense of well-being, including aspects of happiness and satisfaction with life as a whole


  • Kidney transplantation has moved from an experimental treatment to standard management for end-stage renal diseases. Prolongation in survival is accepted, but evaluation of long-term effects on patients’ quality of life (QOL) and its enhancement is the new objective.


  • Comprehensive measurement of posttransplantation health-related quality of life (HRQL) are important for several reasons:

    • Patients are more concerned about QOL than longevity.

    • Kidney transplant recipients may have debilitating fatigue, bone pain, loss of self-esteem, depression, and complications of immunosuppression, which are poorly evaluated through traditional clinical outcomes.

    • Provide valuable information to the health professionals to focus their treatment and procedures towards the most affected areas of recipients’ lives.

    • Provide key components of an evaluation of both effectiveness and cost-effectiveness, which are of particular importance given the cost and scarcity of the resources involved in kidney transplantation (KT)

  • Measuring of QOL helps to address the overall health status of KT recipients.

  • Method for measuring QOL:

  • Pretransplant predictors of QOL (Table 75-2):

  • Employment: interval without work prior to KT and pre-KT diagnosis correlated with the likelihood of employment after KT

  • Sexual functioning: In most cases there isn’t a perceptible improvement, perceptions of sexual health are likely to be psychological rather than endocrine, since endocrine function typically recovers after KT

  • Effect of immunosuppressant medication (Table 75-3):

    • Increased risk of infections

    • Metabolic complications such as hypertension, diabetes mellitus (DM), hyperlipidemia, obesity, and gout

      • Cardiovascular disease and renal failure are the leading nonhepatic causes of morbidity and mortality late after KT

    • De novo cancers, including posttransplant lymphoproliferative disorder

    • Psychological effects associated with steroid therapy aren’t common

  • Strategies to improve QOL in post-KT patients

    • Monitoring of renal function

    • Bone mineral density screenings should be done

  • Immunization

    • Annual influenza vaccination

    • Avoid live virus vaccines

    • Reimmunization is indicated for the pneumococcal vaccine (every 3–5 years)

  • Behavioral intervention

    • Psychoeducational counseling

      • Frequent handwashing

      • Avoid unnecessary sun exposure

      • During periods of maximal immunosuppression, avoid crowds

      • Avoid consumption of water from lakes and rivers, unpasteurized milk products, and raw and undercooked eggs and meats

      • Avoid high-risk pets, which include rodents, reptiles, and birds

      • Reduction of travel-related risks

      • Sustained cessation of smoking

      • Preconception counseling about contraception and the risks and outcomes of pregnancy

    • Exercise and dietary counseling

TABLE 75-1Generic Instruments for the Evaluation of QOL (review pathology)

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