Work disability, functional limitations, and the health status of kidney transplantation recipients posttransplant

Abstract

A primary objective of renal replacement therapy is patient rehabilitation. Studies have consistently shown that transplant recipients are better rehabilitated than patients maintained on dialysis, but diabetic transplant recipients do not do as well as nondiabetics. Few studies have evaluated the rehabilitation status of transplant recipients based upon their outcome following transplantation. Data were collected from 226 patients associated with 5 major transplant centers in the United States at 2.5-3.5 years posttransplant. Established survey procedures were followed and standard measures of work status, functional ability, and health status were incorporated into self-administered questionnaires. Patients were stratified into 3 groups based upon transplant outcome--those with functioning grafts, those whose grafts failed and were retransplanted, and those who returned to dialysis after graft failure. The presence of diabetes was also documented. Regardless of graft outcome, more patients were able to work than were actually working (61.5% vs 43.4%), although patients with successful transplants, and those who were retransplanted, were both better able to work than patients whose grafts had failed, necessitating a return to dialysis. Diabetic and nondiabetic patients differed in their ability to work (74.4% vs 34.7%). All patient groups reported work-related limitations in activity and associated functional impairments. These were less severe for patients who had functioning grafts. Perceived as well as actual health status varied according to graft outcome and primary disease diagnosis, with both dialysis patients and diabetics reporting poorer health status than patients who had retained their first grafts or who had been retransplanted. Graft outcome and primary renal diagnosis prior to transplant are important predictors of ability to work, functional ability, and health status posttransplant. Retransplantation is not detrimental to patient rehabilitation, whereas return to dialysis results in a measurable decline in activity status. Despite a successful graft, diabetes severely limits the rehabilitation potential of transplant recipients.