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Psychological Symptoms and Quality of Life After Simultaneous Kidney and Pancreas Transplantation.

ABSTRACT: Patients that have undergone successful simultaneous pancreas/kidney (SPK) transplantation attain normoglycemia and are free from dialysis. However, only a minor improvement in quality of life (QOL) has been demonstrated. Here, we evaluated the role of psychological symptoms in QOL after SPK transplantation.

Methods

We assessed patients with type 1 diabetes and end-stage renal disease waitlisted for SPK transplantation (pre-SPK, n = 47), and recipients of an SPK transplant (post-SPK, n = 72). Matched patients with type 1 diabetes without end-stage renal disease were included as reference group (type 1 diabetes [T1D] reference group, n = 42). The brief symptom inventory (BSI) was used to measure psychological symptoms. The Short Form-36 (SF-36) was used to determine QOL.

Results

Post-SPK patients scored slightly better on the SF-36 than pre-SPK patients ("General health" 47.2 ± 23.1 versus 37.5 ± 18.1 [P = 0.017]). In the T1D reference group, this score was 60.6 ± 22.3. Post- and pre-SPK patients had similar BSI scores (0.54 ± 0.55 and 0.45 ± 0.42, respectively [P = 0.34]). This score was better in the T1D reference group (BSI score 0.32 ± 0.33). The BSI score inversely correlated with the SF-36 (r = -0.61, P < 0.001).

Conclusions

Psychological symptoms are prevalent in both pre-SPK and post-SPK patients and could play an important role in the reduced QOL observed in these groups.

SUBMITTER: Nijhoff MF

PROVIDER: S-EPMC7213608 | biostudies-literature | 2020 May

REPOSITORIES: biostudies-literature

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Psychological Symptoms and Quality of Life After Simultaneous Kidney and Pancreas Transplantation.

Nijhoff Michiel F MF Hovens Jacqueline G F M JGFM Huisman Sasja D SD Ringers Jan J Rabelink Ton A J TAJ de Fijter Hans J W HJW van der Boog Paul J M PJM de Koning Eelco J P EJP

Transplantation direct 20200427 5

Patients that have undergone successful simultaneous pancreas/kidney (SPK) transplantation attain normoglycemia and are free from dialysis. However, only a minor improvement in quality of life (QOL) has been demonstrated. Here, we evaluated the role of psychological symptoms in QOL after SPK transplantation.<h4>Methods</h4>We assessed patients with type 1 diabetes and end-stage renal disease waitlisted for SPK transplantation (pre-SPK, n = 47), and recipients of an SPK transplant (post-SPK, n = ...[more]

PMID: 32548246

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Project description:BackgroundPancreas transplant alone (PTA) recipients are more affected by pancreas graft thrombosis, and graft loss compared to simultaneous pancreas-kidney (SPK) recipients. The pathophysiology is unknown, but an increased immune response has been suggested in the PTA recipients. In this observational study, we compared perioperative thromboinflammation between PTA (n=32) and SPK (n=35) recipients, and between PTA recipients with (n=14) versus without (n=18) early graft thrombosis.MethodsWe measured C-reactive protein (CRP), plasma markers of activated coagulation and complement, and cytokines preoperatively and daily during the first postoperative week.ResultsPreoperatively, coagulation and complement activation markers were comparable between PTA and SPK recipients, while cytokine concentrations were higher in SPK recipients (TNF, IL-8, IP-10, MCP-1, MIP-1α; all p<0.05). On the first postoperative day, PTA recipients had higher coagulation activation, measured as thrombin-antithrombin complex (TAT), than SPK recipients (p=0.008). In the first postoperative week, PTA recipients showed higher relative cytokine release (IL-6, IL-8, G-CSF, IP-10, MCP-1, and MIP-1α; all p<0.05) while SPK recipients showed higher absolute cytokine concentrations (TNF, IL-1ra, IL-8, MIP-1α, and IL-4; all p<0.05). PTA and SPK recipients showed similar terminal complement complex (TCC, sC5b-9) activation. On the first postoperative day, TCC (OR 1.2 [95% CI 1.0-1.5] for 0.1 CAU/ml increase, p=0.02) and CRP (OR 1.2 [95% CI 1.0-1.3] for 10 mg/L increase, p=0.04) were associated with an increased risk of early graft thrombosis. TCC was specific for graft thrombosis, while CRP increased with several complications. PTA recipients with compared to those without graft thrombosis had higher TCC pre- (p=0.04) and postoperatively (p=0.03).ConclusionThe relative increase in postoperative thromboinflammatory response was more pronounced in PTA recipients. Complement activation was associated with an increased risk of graft thrombosis. This study indicates that innate immune activation rather than elevated levels may affect early postoperative pancreas graft thrombosis.Clinical trial registrationhttps://clinicaltrials.gov/ct2/show/NCT01957696, identifier NCT01957696.

Dataset Information

Psychological Symptoms and Quality of Life After Simultaneous Kidney and Pancreas Transplantation.

Methods

Results

Conclusions

Publications

Psychological Symptoms and Quality of Life After Simultaneous Kidney and Pancreas Transplantation.

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