AUTHOR=Wang Yiman , Van Der Boog Paul , Hemmelder Marc H. , Dekker Friedo W. , De Vries Aiko , Meuleman Yvette 

TITLE=Understanding Health-Related Quality of Life in Kidney Transplant Recipients: The Role of Symptom Experience and Illness Perceptions

JOURNAL=Transplant International

VOLUME=Volume 36 - 2023

YEAR=2023

URL=https://www.frontierspartnerships.org/journals/transplant-international/articles/10.3389/ti.2023.10837

DOI=10.3389/ti.2023.10837

ISSN=1432-2277

ABSTRACT=Abstract 
Purpose: To explore possibilities investigate the impact of symptom experience on health related quality of life (HRQOL) in kidney transplant recipients (KTRs) and whether illness perceptions mediated this impact.

Methods: Symptom experience, illness perceptions, and HRQOL were measured at transplantation and 6 weeks after transplantation using validated questionnaires in adult KTRs participating in an ongoing Dutch cohort study. Multivariable linear regression models were used to evaluate the effect of symptom experience on HRQOL and the mediation effect. Bootstrapping method was used to calculate the 95% confidence interval (CI) for the mediation effect. 

Results: 90 KTRs completed questionnaires and were included in the analysis. Fatigue and lack of energy were the most prevalent and burdensome symptoms reported by patients at transplantation. Mental HRQOL at 6 weeks after transplantation was comparable to that of the general Dutch population (mean [standard deviation, SD]: 49.9[10.7]) versus 50.2[9.2]), while physical HRQOL was significantly lower (38.9[9.1] versus 50.6[9.2]). Experiencing more symptoms was associated with lower physical and mental HRQOL, and the corresponding HRQOL reduced by -0.15 (95%CI, -0.31;0.02) and -0.23 (95%CI, -0.42;-0.04) with each additional symptom. The identified mediation effect of illness perceptions suggests that worse symptom experiences could cause more unhelpful illness perceptions and consequently lead to lower HRQOL. 

Conclusion: Illness perceptions can potentially explain the negative impact of symptom experience on HRQOL in KTRs. Future studies at later stages after kidney transplantation are needed to further explore the mediation effect of illness perceptions and guide clinical practice to improve HRQOL.