Symptom Burden and Patient-Reported Outcomes in Kidney Transplant Recipients: Results From the TransplantLines...

A multitude of symptoms may contribute to low health-related quality of life (HRQoL) in kidney transplant recipients (KTR). We aimed to identify the most occurring and distressing symptoms, to explore potential determinants of symptom burden, and to examine associations with patient-reported outcomes in KTR.

A cross-sectional retrospective patient-reported outcome measures study.

Stable KTR ≥1 year after transplantation participating in the TransplantLines Biobank and Cohort Studies.

Clinical variables, including sex, age, and time after transplantation.

Symptom occurrence/distress/burden, medication adherence, symptoms of depression/anxiety, societal participation, and HRQoL.

Symptoms were evaluated using ridit analyses. A burden score was calculated to explore determinants of symptom burden and its associations with other patient-reported outcomes.

We included 936 KTR (38.8% female; mean ± SD age, 55.6 ± 13.0 years) at a median [IQR] of 2.0 [1.0-9.0] years after transplantation. Based on ridit scores, most occurring symptoms were tiredness [0.724], bruises [0.718], and lack of energy [0.688]; most distressful symptoms were menstrual problems [0.679], impotence [0.654], and joint pain [0.611]. Worse nutritional status (P < 0.001), being female (P < 0.001), cyclosporine use (P = 0.005), and proton pomp inhibitor use (P < 0.001) were associated with higher symptom burden. Higher symptom burden was associated with medication nonadherence, symptoms of depression and anxiety, lower societal participation, and lower physical and mental HRQoL (st.β = -0.53, 95% CI -0.59 to -0.47, P <0.001 and st.β=-0.53, 95% CI -0.60 to -0.46, P < 0.001, respectively).

No causality can be established because of the cross-sectional design.

The most occurring symptoms were tiredness, bruises, and lack of energy, and the most distressing symptoms were menstrual problems, impotence, and joint pain. The strongest determinants of symptom burden were female sex, malnutrition, cyclosporine use, and proton pump inhibitor use. The associations of symptom burden with patient-related outcomes underline the importance of addressing symptom status after transplant.