Affiliation:
1. Center for Healthcare Equity in Kidney Disease (CHEK‐D) University of New Mexico Health Sciences Albuquerque New Mexico USA
2. Durham VA Medical Center Durham North Carolina USA
3. College of Population Health University of New Mexico Albuquerque New Mexico USA
4. Department of Internal Medicine University of Washington Seattle Washington USA
5. Department of Internal Medicine University of New Mexico School of Medicine Albuquerque New Mexico USA
6. Department of Psychiatry University of Pittsburgh School of Medicine Pittsburgh Pennsylvania USA
7. Department of Medical Social Sciences and Transplant Outcomes Research Collaboration Feinberg School of Medicine Northwestern University Chicago Illinois USA
8. Highmark Health Pittsburgh Pennsylvania USA
9. Department of Medicine University of Pittsburgh School of Medicine Pittsburgh Pennsylvania USA
10. Mount Sinai Recanati/Miller Transplantation Institute Icahn School of Medicine New York USA
Abstract
AbstractBackgroundPost‐transplant health‐related quality of life (HRQOL) is associated with health outcomes for kidney transplant (KT) recipients. However, pretransplant predictors of improvements in post‐transplant HRQOL remain incompletely understood. Namely, important pretransplant cultural factors, such as experience of discrimination, perceived racism in healthcare, or mistrust of the healthcare system, have not been examined as potential HRQOL predictors. Also, few have examined predictors of decline in HRQOL post‐transplant.MethodsUsing data from a prospective cohort study, we examined HRQOL change pre‐ to post‐transplant, and novel cultural predictors of the change. We measured physical, mental, and kidney‐specific HRQOL as outcomes, and used cultural factors as predictors, controlling for demographic, clinical, psychosocial, and transplant knowledge covariates.ResultsAmong 166 KT recipients (57% male; mean age 50.6 years; 61.4% > high school graduates; 80% non‐Hispanic White), we found mental and physical, but not kidney‐specific, HRQOL significantly improved post‐transplant. No culturally related factors outside of medical mistrust significantly predicted change in any HRQOL outcome. Instead, demographic, knowledge, and clinical factors significantly predicted decline in each HRQOL domain: physical HRQOL—older age, more post‐KT complications, higher pre‐KT physical HRQOL; mental HRQOL—having less information pre‐KT, greater pre‐KT mental HRQOL; and, kidney‐specific HRQOL—poorer kidney functioning post‐KT, lower expectations for physical condition to improve, and higher pre‐KT kidney‐specific HRQOL.ConclusionsInstead of cultural factors, predictors of HRQOL decline included demographic, knowledge, and clinical factors. These findings are useful for identifying patient groups that may be at greater risk of poorer post‐transplant outcomes, in order to target individualized support to patients.