Perspectives of Older Kidney Transplant Recipients on Kidney Transplantation

Abstract

Background and objectives: Older kidney transplant recipients are susceptible to cognitive impairment, frailty, comorbidities, immunosuppression-related complications, and chronic graft failure, however, there has been limited focus on their concerns and expectations related to transplantation. This study aims to describe the perspectives of older kidney transplant recipients about their experience of kidney transplantation, self-management, and treatment goals to inform strategies and interventions that address their specific needs.

Design, setting, participants, & measurements: Face-to-face semistructured interviews were conducted with 30 kidney transplant recipients aged 65-80 years from five renal units in Australia. Transcripts were analyzed thematically.

Results: Six themes were identified: restoring vitality of youth (with subthemes of revived mindset for resilience, embracing enjoyment in life, drive for self-actualization); persisting through prolonged recovery (yielding to aging, accepting functional limitations, pushing the limit, enduring treatment responsibilities); imposing sicknesses (combatting devastating comorbidities, painful restrictions, emerging disillusionment, anxieties about accumulating side effects, consuming treatment burden); prioritizing graft survival (privileged with a miracle, negotiating risks for longevity, enacting a moral duty, preserving the last opportunity); confronting health deterioration (vulnerability and helplessness, narrowing focus to immediate concerns, uncertainty of survival); and value of existence (purpose through autonomy, refusing the burden of futile treatment, staying alive by all means).

Conclusions: Older kidney transplant recipients felt able to enjoy life and strived to live at their newly re-established potential and capability, which motivated them to protect their graft. However, some felt constrained by slow recuperation and overwhelmed by unexpected comorbidities, medication-related side effects, and health decline. Our findings suggest the need to prepare and support older recipients for self-management responsibilities, clarify their expectations of post-transplant risks and outcomes, and provide assistance through prolonged recovery after kidney transplantation.

Keywords: Australia; adolescent; aging; anxiety; cognition disorders; comorbidity; geriatric nephrology; goals; graft survival; humans; immunosuppression; kidney transplantation; longevity; medical futility; moral obligations; motivation; negotiating; quality of life; self-care; transplant outcomes; transplant recipients; uncertainty.

Figure 1.

Thematic schema of the perspectives of older kidney transplant recipients. Kidney transplantation restores vitality and autonomy for older kidney transplant recipients, which enables them to enjoy life, and strive to fulfill their now attainable goals. They prioritize the functioning of their graft, as they feel grateful, privileged, and responsible to preserve what could be their final chance of recuperation. However, “persisting through prolonged recovery,” and “imposing sicknesses” challenge the regained vitality. Some participants may experience the consequences of health decline. If they confront deterioration in health, older kidney transplant recipients may feel vulnerable and uncertain of their survival. This can lead some to question the value of their own existence.