Kidney Function

Background: Few risk factors for quality-of-life outcomes of simultaneous pancreas and kidney transplant recipients are known because of a paucity of data from prospective studies.Study Design: Pretransplant assessment and prospective 3-year follow-up.Setting & Participants: Consecutive potential recipients at a university teaching hospital assessed by Liaison Psychiatry.Predictors: Demographic data; pretransplant Transplant Evaluation Rating Scale scores; current, past 12 months, and prior lifetime psychiatric disorder.Outcomes & Measurements: 36-Item Short Form Health Survey (SF-36) scores.Results: 37 simultaneous pancreas and kidney transplant recipients were assessed pretransplant and at 4 months posttransplant. Posttransplant at 1 year, 29 (81% of survivors); at 2 years, 26 (79% of survivors and those reaching 2 years); and at 3 years, 22 (92% of survivors and those reaching 3 years) patients were assessed. SF-36 Mental Component Summary (MCS) scores (mean pretransplant, 46.8 ± 8.2 [SD]; 4 months, 51.7 ± 8.5; 1 year, 50.1 ± 9.7; 2 years, 51.8 ± 8.9; and 3 years, 50.8 ± 13.8) and Physical Component Summary (PCS) scores (pretransplant, 40.6 ± 10.6; 4 months, 43.6 ± 12.0; 1 year, 45.6 ± 11.3; 2 years, 48.1 ± 10.2; and 3 years, 46.8 ± 9.1) showed sustained improvement posttransplant. MCS scores became similar to population norms. Functionally significant decreases in MCS and PCS scores were seen in 4%-21% and 8%-30% at times posttransplant. Male sex predicted higher scores at 4 months for the MCS (P = 0.003; regression coefficient, −8.28 [95% CI, −13.6 to −2.9]; effect size, 0.22) and PCS (P = 0.05; regression coefficient, −6.91 [95% CI, −13.9 to 0.9]; effect size, 0.08). Current psychiatric disorder at pretransplant evaluation predicted higher PCS scores at 4 months (P = 0.002; regression coefficient, −15.42 [95% CI, −24.6 to −6.2]; effect size, 0.22) and 1 year (P = 0.002; regression coefficient, −17.3 [95% CI, −27.9 to −6.7]; effect size, 0.29). Psychiatric disorder before the 12 months before the pretransplant evaluation predicted lower PCS scores at 4 months posttransplant (P < 0.001; regression coefficient, 14.98 [95% CI, 7.1-22.8]; effect size, 0.29).Limitations: Cohort size.Conclusions: Although half experienced sustained quality-of-life improvement, up to one-third experienced a decrease. Past psychiatric disorder is a risk factor. Patients should be educated and monitored appropriately.