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

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Transplant International

Abstract

Tacrolimus is increasingly used as a baseline immunosuppressant after renal transplantation. This multicentre study assessed health-related quality of life and symptom experience in renal transplant patients on tacrolimus-based therapy, using the SF-36 and Euroqol 5 dimensions (EQ-5D) 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.

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References

  1. Aaronson NK, Muller M, Cohen PD, Essink-Bot ML, Fekkes M, Sanderman R, Sprangers MA, te Velde A, Verrips E (1998) Translation, validation, and norming of the Dutch language version of the SF-36 Health Survey in community and chronic disease populations. J Clin Epidemiol 51:1055–1068

    Article  CAS  Google Scholar 

  2. Baecke JA, Burema J, Frijters JE (1982) A short questionnaire for the measurement of habitual physical activity in epidemiological studies. Am J Clin Nutr 36:936–942

    CAS  PubMed  Google Scholar 

  3. Beck AT, Steer RA, Garbin MG (1988) Psychometric properties of the Beck Depression Inventory: twenty-five years of evaluation. Clin Psychol Rev 8:77–100

    Article  Google Scholar 

  4. Benedetti E, Matas AJ, Hakim N, Fasola C, Gillingham K, McHugh L, Najarian JS (1994) Renal transplantation for patients 60 years and older. A single-institution experience. Ann Surg 220:445–458

    CAS  PubMed  Google Scholar 

  5. Brooks R (1996) EuroQol: the current state of play. Health Policy 37:53–72

    Article  CAS  PubMed  Google Scholar 

  6. Bross IDJ (1958) How to use ridit analysis. Biometrics 14:18–38

    Google Scholar 

  7. Campo JV, Smith C, Perel JM (1998) Tacrolimus toxic reaction associated with the use of nefazodone: paroxetine as an alternative agent. Arch Gen Psychiatry 55:1050–1052

    Article  CAS  Google Scholar 

  8. De Geest S, Moons P (2000) The patient's appraisal of side effects: the blind spot in quality-of-life assessments in transplant recipients (editorial). Nephrol Dial Transplant 15:457–459

    Article  PubMed  Google Scholar 

  9. De Geest S, Abraham I, Moons P, Vandeputte M, Van Cleemput J, Evers G, Daenen W, Vanhaecke J (1998) Late acute rejection and subclinical noncompliance with cyclosporine therapy in heart transplant recipients. J Heart Lung Transplant 17:854–863

    PubMed  Google Scholar 

  10. Dew MA, Harris RC, Simmons RG, Roth LH, Armitage JM, Griffith BP (1991) Quality-of-life advantages of FK 506 vs conventional immunosuppressive drug therapy in cardiac transplantation. Transplant Proc 23:3061–3064

    CAS  PubMed  Google Scholar 

  11. Dew MA, Switzer GE, Goycoolea JM, Allen AS, DiMartini A, Kormos RL, Griffith BP (1997) Does transplantation produce quality of life benefits? A quantitative analysis of the literature. Transplantation 64:1261–1273

    CAS  PubMed  Google Scholar 

  12. Dew MA, Kormos RL, Roth LH, Murali S, DiMartini A, Griffith BP (1999) Early post-transplant medical compliance and mental health predict physical morbidity and mortality one to three years after heart transplantation. J Heart Lung Transplant 18:549–562

    Article  CAS  PubMed  Google Scholar 

  13. DiMatteo MR, Lepper HS, Croghan TW (2000) Depression is a risk factor for noncompliance with medical treatment: meta-analysis of the effects of anxiety and depression on patient adherence. Arch Intern Med 160:2101–2107

    Article  CAS  PubMed  Google Scholar 

  14. Dobbels F, De Geest S, Vanhees L, Schepens K, Fagard R, Vanhaecke J (2002) Depression and the heart: a systematic overview of definition, measurement, consequences and treatment of depression in cardiovascular disease. Eur J Cardiovasc Nurs 1:45–55

    Article  Google Scholar 

  15. Dolan P, Gudex C, Kind P, Williams A (1996) Valuing health states: a comparison of methods. J Health Econ 15:209–231

    Article  CAS  PubMed  Google Scholar 

  16. Ernst E (2002) St John's wort supplements endanger the success of organ transplantation. Arch Surg 137:316–319

    Article  CAS  PubMed  Google Scholar 

  17. Felser I, Wagner S, Depee J, Johnson N, Staschak S, Jain A, Fung JJ, Starzl TE (1991) Changes in quality of life following conversion from CyA to FK 506 in orthotopic liver transplant patients. Transplant Proc 23:3032–3034

    CAS  PubMed  Google Scholar 

  18. Fujisawa M, Ichikawa Y, Yoshiya K, Isotani S, Higuchi A, Nagano S, Arakawa S, Hamami G, Matsumoto O, Kamidono S (2000) Assessment of health-related quality of life in renal transplant and hemodialysis patients using the SF-36 health survey. Urology 56:201–206

    Article  CAS  PubMed  Google Scholar 

  19. Horton RC, Bonser RS (1995) Interaction between cyclosporin and fluoxetine. Br Med J 311:422

    CAS  Google Scholar 

  20. Khan IH, Garratt AM, Kumar A, Cody DJ, Catto GR, Edward N, Macleod AM (1995) Patients' perception of health on renal replacement therapy: evaluation using a new instrument. Nephrol Dial Transplant 10:684–689

    CAS  PubMed  Google Scholar 

  21. Lewis BR, Aoun SL, Bernstein GA, Crow SJ (2001) Pharmacokinetic interactions between cyclosporine and bupropion or methylphenidate. J Child Adolesc Psychopharmacol 11:193–198

    Article  CAS  PubMed  Google Scholar 

  22. Lutkes P, Franke G, Witzke O, Zimmermann U, Kohnle M, Philipp T, Heemann U (1999) Lebensqualität nach Nierentransplantation. Einfluss neuer immunsuppressiver Substanzen (Quality of life following transplantation. The impact of a new immunosuppressive substance). Zentralbl Chir 124:90–94

    CAS  PubMed  Google Scholar 

  23. Matas AJ, McHugh L, Payne WD, Wrenshall LE, Dunn DL, Gruessner RW, Sutherland DE, Najarian JS (1998) Long-term quality of life after kidney and simultaneous pancreas–kidney transplantation. Clin Transplant 12:233–242

    CAS  PubMed  Google Scholar 

  24. Moons P, De Geest S, Abraham I, Van Cleemput J, Van Vanhaecke J (1998) Symptom experience associated with maintenance immunosuppression after heart transplantation: patients' appraisal of side effects. Heart Lung 27:315–325

    CAS  PubMed  Google Scholar 

  25. Moons P, Fairchild S, De Geest S (1999) Patients' appraisal of side effects in quality of life assessments of immunosuppressive regimens. In: Cochat P, Traeger J, Merieux C, Derchavane M (eds) Immunosuppression under trial. Kluwer Academic Publishers, Dordrecht, pp 69–80

  26. Moons P, De Geest S, Versteven K, Abraham I, Vlaminck H, Moens G, Waer M (2001) Psychometric properties of the "Modified Transplant Symptom Occurrence and Symptom Distress Scale". J Nurs Meas 9:115–134

    CAS  PubMed  Google Scholar 

  27. Nielens H, Lejeune TM, Lalaoui A, Squifflet JP, Pirson Y, Goffin E (2001) Increase of physical activity level after successful renal transplantation: a 5 year follow-up study. Nephrol Dial Transplant 16:134–140

    Article  CAS  PubMed  Google Scholar 

  28. Olyaei AJ, deMattos AM, Norman DJ, Bennett WM (1998) Interaction between tacrolimus and nefazodone in a stable renal transplant recipient. Pharmacotherapy 18:1356–1359

    CAS  PubMed  Google Scholar 

  29. Reimer J, Franke GH, Luetkes P, Kohnle M, Philipp T, Heemann U (2001) Quality of life after kidney transplantation—the impact of tacrolimus. Transplant Proc 33:1924–1926

    Article  CAS  PubMed  Google Scholar 

  30. Reimer J, Franke GH, Philipp T, Heeman U (2002) Quality of life in kidney recipients: comparison of tacrolimus and cyclosporine-microemulsion. Clin Transplant 16:48–54

    Article  PubMed  Google Scholar 

  31. Scheier MF, Bridges MW (1995) Person variables and health: personality predispositions and acute psychological states as shared determinants for disease. Psychosom Med 57:255–268

    CAS  PubMed  Google Scholar 

  32. Schlebusch L, Pillay BJ, Louw J (1989) Depression and self-report disclosure after live related donor and cadaver renal transplants. S Afr Med J 75:490–493

    CAS  PubMed  Google Scholar 

  33. Schlenk EA, Erlen JA, Dunbar-Jacob J, McDowell J, Engberg S, Sereika SM, Rohay JM, Bernier MJ (1998) Health-related quality of life in chronic disorders: a comparison across studies using the MOS SF-36. Qual Life Res 7:57–65

    Article  CAS  PubMed  Google Scholar 

  34. Scholler G, Rose M, Neuhaus R, Neuhaus P, Klapp BF (1997) Comparison of cyclosporine A and FK506 with regard to complaints and psychosocial characteristics before and after liver transplantation. Transplant Proc 29:2491–2493

    Article  CAS  PubMed  Google Scholar 

  35. Shield CF III, McGrath MM, Goss TF (1997) Assessment of health-related quality of life in kidney transplant patients receiving tacrolimus (FK506)-based versus cyclosporine-based immunosuppression. FK506 Kidney Transplant Study Group. Transplantation 64:1738–1743

    CAS  PubMed  Google Scholar 

  36. Teixeira de Barros C, Cabrita J (1999) Self-report of symptom frequency and symptom distress in kidney transplant recipients. Pharmacoepidemiol Drug Saf 8:395–403

    Article  Google Scholar 

  37. Testa MA, Simonson DC (1996) Assessment of quality-of-life outcomes. N Engl J Med 334:835–840

    CAS  PubMed  Google Scholar 

  38. Tsuji-Hayashi Y, Fukuhara S, Green J, Takai I, Shinzato T, Uchida K, Oshima S, Yamazaki C, Maeda K (1999) Health-related quality of life among renal-transplant recipients in Japan. Transplantation 68:1331–1335

    CAS  PubMed  Google Scholar 

  39. van den Ham EC, Kooman JP, Christiaans MH, van Hooff JP (2000) Relation between steroid dose, body composition and physical activity in renal transplant patients. Transplantation 69:1591–1598

    PubMed  Google Scholar 

  40. Vella JP, Sayegh MH (1998) Interactions between cyclosporine and newer antidepressant medications. Am J Kidney Dis 31:320–323

    CAS  PubMed  Google Scholar 

  41. von Steinbuchel N, Limm H, Leopold C, Carr D (2000) Assessment of health-related quality-of-life in patients after heart transplantation under therapy with tacrolimus or cyclosporine. Transplant Int 13 [Suppl 1]: S609–S614

    Google Scholar 

  42. Ware JE, Jr., Snow KK, Kosinski M, Gandek B (1993) SF-36 Health survey: manual and interpretation guide. The Health Institute, New England Medical Center, Boston

  43. Whiting JF (2000) Standards for economic and quality of life studies in transplantation. Transplantation 70:1115–1121

    CAS  PubMed  Google Scholar 

  44. Wong EH, Chan NN, Sze KH, Or KH (2002) Serotonin syndrome in a renal transplant patient. J R Soc Med 95:304–305

    Article  CAS  PubMed  Google Scholar 

  45. Wright DH, Lake KD, Bruhn PS, Emery RW Jr (1999) Nefazodone and cyclosporine drug–drug interaction. J Heart Lung Transplant 18:913–915

    Article  CAS  PubMed  Google Scholar 

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Acknowledgements

This study was supported by an unrestricted scientific grant from Fujisawa GmbH, Germany. The authors wish to thank Dr. J. Dumon and Dr T. Schindler for the critical evaluation of previous versions of the manuscript.

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Authors and Affiliations

  1. Centre for Health Services and Nursing Research, Katholieke Universiteit of Leuven, Kapucijnenvoer 35/4, 3000, Leuven, Belgium

    Philip Moons, Dave Margodt & Sabina De Geest

  2. Department of Nephrology, University Hospitals of Leuven, Leuven, Belgium

    Yves Vanrenterghem

  3. Department of Nephrology, Academic Hospital of Maastricht, Maastricht, The Netherlands

    Johannes P. van Hooff & Monique Mullens

  4. Department of Kidney and Pancreas Transplantation, Cliniques Universitaires Saint-Luc, Brussels, Belgium

    Jean-Paul Squifflet & Isabelle Thevissen

  5. Institute of Nursing Science, University of Basel, Basel, Switzerland

    Sabina De Geest

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  1. Philip Moons
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  2. Yves Vanrenterghem
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  3. Johannes P. van Hooff
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  8. Sabina De Geest
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Correspondence to Philip Moons.

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Moons, P., Vanrenterghem, Y., van Hooff, J.P. et al. Health-related quality of life and symptom experience in tacrolimus-based regimens after renal transplantation: a multicentre study. Transpl Int 16, 653–664 (2003). https://doi.org/10.1007/s00147-003-0595-1

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  • DOI: https://doi.org/10.1007/s00147-003-0595-1

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