Patient Preference and Adherence (May 2019)
Psychological processing of a kidney transplantation, perceived quality of life, and immunosuppressant medication adherence
Abstract
Jennifer Scheel,1 Katharina Schieber,1 Sandra Reber,1 Sabine Jank,2 Kai-Uwe Eckardt,2 Franziska Grundmann,3 Frank Vitinius,4 Martina de Zwaan,5 Anna Bertram,6 Yesim Erim11Department of Psychosomatic Medicine and Psychotherapy, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany; 2Department of Nephrology and Hypertension, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany; 3Department II of Internal Medicine, Nephrology, Rheumatology, Diabetes and General Internal Medicine, University Hospital of Cologne, Cologne, Germany; 4Department of Psychosomatics and Psychotherapy, University Hospital of Cologne, Cologne, Germany; 5Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Germany; 6Department of Nephrology and Hypertension, Hannover Medical School, Hanover, GermanyIntroduction: Though psychosocial well-being and quality of life generally improve after transplantation, a relevant proportion of patients suffers from psychosocial problems. Further analysis of the psychological coping after kidney transplantation is needed to identify patients at risk. The aim of this study was to examine the psychological response after kidney transplantation and its associations with health-related quality of life and immunosuppressant medication adherence.Materials and methods: The coping process after kidney transplantation was investigated with the Transplant Effects Questionnaire (TxEQ; subscales: worry, guilt, disclosure, adherence, responsibility) in 267 adult kidney transplant recipients ≥12 months post-transplantation. Furthermore, perceived health-related quality of life, self-reported immunosuppressant medication adherence, and sub-therapeutic immunosuppressant trough levels as biological markers of adherence were assessed.Results: Patients showed moderate scores concerning the subscales “worry”, “guilt”, and “responsibility” as well as high scores concerning “disclosure”. Except for “adherence”, all TxEQ subscales were associated with mental, but not with physical health-related quality of life and self-reported adherence. Sub-therapeutic immunosuppressant trough levels were significantly associated only with the TxEQ subscale “worry”.Conclusions: The present results suggest a conditional structure in which mental health-related quality of life is negatively associated with worries, guilt, and responsibility and positively with disclosure. Adherence seems to be a complex behavior, which is not necessarily directly associated with the psychological processing of organ transplantations. As mental health-related quality of life is related to this psychological processing, the TxEQ could be used as a screening tool for problematic psychological processing after kidney transplantation.Keywords: kidney transplantation, psychological processing, Transplant Effects Questionnaire, health-related quality of life, adherence, immunosuppressant trough levels
