Research reveals deceased-donor kidney transplants can improve quality of life as much as living-donor kidney transplants
It is commonly believed by clinical staff working with kidney transplant recipients that transplants from living donors result in better quality of life than transplants from deceased donors.
A new study led by health psychologists at Royal Holloway, University of London and transplant surgeons at the Cambridge University Hospitals NHS Trust, funded by the National Institute for Health Research (NIHR), reveals for the first time that kidney transplants from deceased donors lead to similar improvements in patients’ quality of life as kidneys from living donors.
Most of the research published to date, claiming to show better quality of life in living-donor kidney recipients, has actually used measures of health status rather than measures of quality of life and has not always controlled for pre-transplant differences in factors such as age and time on dialysis which will affect health status.
This new study uses genuine measures of quality of life as well as measures of health status and other patient-reported outcome measures instead of relying solely on health status tools. The new study also controls for pre-transplant differences between living-donor transplant recipients and deceased-donor transplant recipients which would otherwise give the appearance of better outcomes in the living-donor recipients. After controlling for pre-transplant differences, there was no difference in quality of life at 12-month follow-up between living-donor recipients and deceased-donor recipients. Treatment satisfaction was the only patient-reported outcome that remained significantly improved in the living-donor recipients after controlling for confounding factors including the younger age of living-donor recipients and less time on dialysis prior to transplantation.
Professor Clare Bradley, professor emerita of health psychology at Royal Holloway, said: “We hope that our findings will help patients and their relatives and friends make difficult choices and help their clinicians advise them well. Living donation cannot be assumed to be the best option: a deceased donor kidney can result in equally good outcomes without the risk of harm to the health and quality of life of a living donor”.
Professor Chris Watson, from Cambridge University Hospitals NHS Trust, said: “The results of this study have important implications for clinicians and patients alike.
The work that Professor Clare Bradley and her team at Royal Holloway have done, in collaboration with every renal clinic in the UK, has the potential to make a real difference to kidney transplantation and how its outcomes are evaluated. I hope that this study will be the start of routine collection of patient-reported outcomes, including quality of life, alongside health outcomes to allow us to understand better how to help improve the lives of patients with chronic kidney disease”.
Published paper in BMJ Open on the ‘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‘.
