A Prospective Study of Depression and Quality of Life After Kidney Transplantation.

Background: Depression and diminished health-related quality of life (HRQOL) are common in kidney failure. In this study we investigate whether kidney transplant (KT), the treatment of choice for kidney failure, improves depression and HRQOL across lifespan and whether this effect is sustained.

Methods: In this longitudinal observational cohort study, we assessed depression and HRQOL in patients on the KT waitlist and again at 3-months and 1-year after KT. We measured depression using the Beck Depression Inventory-II (BDI-II) and HRQOL using the Kidney Disease Quality of Life Short Form Version 1.3 (KDQOL-SF) physical health composite score (PCS) and mental health composite score (MCS). We used linear mixed effect models with random intercepts for patients to evaluate the effect of time, age, and KT status on BDI-II score, PCS, and MCS. For models with significant age interactions, we estimated this effect for baseline age groups.

Results: We analyzed 239 longitudinal BDI-II assessments completed by 99 patients and 143 KDQOL-SF assessments completed by 59 patients (16% Black, 79% White). The BDI-II scores improved pre- to post-KT (10 pre-KT vs 5 post-KT, p<0.001). PCS improved pre- to post-KT in younger patients, but the magnitude of change was lower with older age (p for interaction=0.01). In the sub-group analysis by age, there was improvement in PCS post-KT in patients <60 years (p=0.003 for 30-39, p=0.007 for 40-49, p=0.03 for 50-59). The MCS also improved from 47 pre-KT to 51 post-KT (p<0.001), and the magnitude of improvement was again lower with older age (p for interaction=0.03).

Conclusions: Depression and HRQOL improve with KT. While depression improves in all ages, the improvement in HRQOL, especially PCS, is more evident in younger patients. This improvement in depression and HRQOL is sustained until at least 1-year post-KT. These data help frame expectations for patients and transplant teams.