(208) Impact of Immunosuppressant Therapies and Transplantation on Health- Related Quality of Life Among Renal Transplant Recipients at a National Referral Hospital in Kenya

Publication Number: 882

Background: Renal transplantation is increasing globally and transplant recipients are required to take immunosuppressive drugs for a long 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.

Objectives: To determine impact of immunosuppressive agents and transplantation on health related quality of life outcomes in renal transplant recipients at Kenyatta National Hospital (KNH).

Methods: A cross-sectional descriptive study involving 80 patients who were consecutively sampled was carried out between 1st July 2021 and 30th September 2021at the renal unit. 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 Kidney transplant questionnaire-25 (KTQ-25). Descriptive and inferential analysis was carried out using STATA version 13. Logistic 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 diarrhoea (23. 8%).The mean(SD) HRQoL was 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).Comorbidity (p=0.017) and immunosuppressant side effects of changes in appearance (p=0.002) and physical symptoms (p=0.011) were significantly associated with low HRQoL. Serum creatinine (aOR= 1.02, 95% CI= 1.01-1.03; P= 0.039) and diabetes (aOR= 6.72, CI=1.35-33.48; P=0.02) were independently associated with low quality of life score.

Conclusions: Generally, HRQoL of kidney transplant patients was good. However, uncertainty and fear were the least scored domains in quality of life assessment. Side effects from immunosuppressant medication had an influence on appearance and physical symptoms. Routine monitoring of serum creatinine and blood sugar levels should be done. Patient counselling is key in management to prevent non-adherence.