Changes in quality of life (QoL) and other patient-reported outcome measures (PROMs) in living-donor and deceased-donor kidney transplant recipients and those awaiting transplantation in the UK ATTOM programme: a longitudinal cohort questionnaire survey with additional qualitative interviews.

To examine quality of life (QoL) and other patient-reported outcome measures (PROMs) in kidney transplant recipients and those awaiting transplantation. Longitudinal cohort questionnaire surveys and qualitative semi-structured interviews using thematic analysis with a pragmatic approach. Completion of generic and disease-specific PROMs at two time points, and telephone interviews with participants UK-wide. 101 incident deceased-donor (DD) and 94 incident living-donor (LD) kidney transplant recipients, together with 165 patients on the waiting list (WL) from 18 UK centres recruited to the Access to Transplantation and Transplant Outcome Measures (ATTOM) programme completed PROMs at recruitment (November 2011 to March 2013) and 1 year follow-up. Forty-one of the 165 patients on the WL received a DD transplant and 26 received a LD transplant during the study period, completing PROMs initially as patients on the WL, and again 1 year post-transplant. A subsample of 10 LD and 10 DD recipients participated in qualitative semi-structured interviews. LD recipients were younger, had more educational qualifications and more often received a transplant before dialysis. Controlling for these and other factors, cross-sectional analyses at 12 months post-transplant suggested better QoL, renal-dependent QoL and treatment satisfaction for LD than DD recipients. Patients on the WL reported worse outcomes compared with both transplant groups. However, longitudinal analyses (controlling for pre-transplant differences) showed that LD and DD recipients reported similarly improved health status and renal-dependent QoL (p<0.01) pre-transplant to post-transplant. Patients on the WL had worsened health status but no change in QoL. Qualitative analyses revealed transplant recipients' expectations influenced their recovery and satisfaction with transplant. While cross-sectional analyses suggested LD kidney transplantation leads to better QoL and treatment satisfaction, longitudinal assessment showed similar QoL improvements in PROMs for both transplant groups, with better outcomes than for those still wait-listed. Regardless of transplant type, clinicians need to be aware that managing expectations is important for facilitating patients' adjustment post-transplant.

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Déclaration de conflit d'intérêts

Competing interests: All authors completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf. Professor Watson reports personal fees from GlaxoSmithKline outside the submitted work. Professor Clare Bradley reports grants from NIHR during the conduct of the study, and grants from NIHR and GlaxoSmithKline/ViiV Healthcare, outside the submitted work. CB is the majority shareholder in a company, Health Psychology Research Ltd, which licenses her patient-reported outcome measures, for others to use. These questionnaires include the RDQoL, RTSQ and W-BQ used in the ATTOM programme. CB owns the copyright in all of these instruments and when they are licensed for use by commercial companies in their clinical trials, receives royalties. All other authors declared no competing interests. The results presented in this paper have not been published previously in whole or part, except in abstract format.