Title: The factors affecting the HRQOL of kidney transplant recipients in the land of Gross National Happiness, Bhutan - A cross-sectional study.

Abstract

Abstract Background Globally the prevalence of renal failure is on the rise. Kidney transplantation is the preferred and most affordable treatment for renal failure with improved health-related quality of life (HRQOL) compared to dialysis. Bhutan lacks kidney transplant facilities in the country, requiring referral to the neighbouring country. The HRQOL in kidney transplants in Bhutan has never been evaluated. The study aimed to investigate the relationships between different factors and HRQOL in kidney transplant recipients. Methods An observational study was conducted from January to July 2022. A kidney transplant recipient who underwent surgery until December 2021 and came for therapeutic drug monitoring (TDM) was recruited. Data on HRQOL were collected by face-to-face interviews using a structured questionnaire. A descriptive analysis wasused to describe sociodemographic characteristics and HRQOL. Factors affecting HRQOL were analysedusing Mann‒WhitneyU and Kruskal‒Wallis tests. Linear regression was used to assess the link between factors and HRQOL. Results One hundred kidney transplant recipients were recruited in this study. Of these, 25 of them did not have a formal education, and 48 are employed. 53.0 % of kidney failures were due to hypertension, and 62 of them had dialysis for less than one year. Overall, physical symptoms contributed to poor HRQOL with a mean ± SD score of 4.9 ± (1.0) and the appearance dimension of better HRQOL at a mean ± SD of 4.0 ± (1.3). Unemployment was significantly associated with poor physical symptoms, uncertainty/fear and emotional dimension. Physical symptoms and age were found to be positive and statistically significant (r = .321, P<0.001). Factors such as age, hematocrit and BMI are linked with physical symptoms, fatigue and appearance. Conclusion Hypertension is the leading cause of kidney failure in Bhutan. The physical symptoms are associated with poor HRQOL among transplant recipients affecting mostly the unemployed. Recipients who are employed and the related donor were found to have better HRQOL.