Impacts of Interaction of Mental Condition and Quality of Life between Donors and Recipients at Decision-Making of Preemptive and Post-Dialysis Living-Donor Kidney Transplantation

Abstract

Pre-emptive kidney transplantation (PEKT) is considered one of the most effective types of kidney replacement therapies to improve the quality of life (QOL) and physical prognosis of patients with end-stage renal disease (ESRD). In Japan, living-donor kidney transplantation is a common therapeutic option for patients undergoing dialyses (PDKT). Moreover, during shared decision-making in kidney replacement therapy, the medical staff of the multidisciplinary kidney team often provide educational consultation programmes according to the QOL and sociopsychological status of the ESRD patient. In Japan, the majority of kidney donations are provided by living family members. However, neither the psychosocial status of donors associated with the decision-making of kidney donations nor the interactions of the psychosocial status between donors and recipients have been clarified in the literature. In response to this gap, the present study determined the QOL, mood and anxiety status of donors and recipients at kidney transplantation decision-making between PEKT and PDKT. Deterioration of the recipient's QOL associated with "role physical" shifted the decision-making to PEKT, whereas deterioration of QOL associated with "role emotional" and "social functioning" of the recipients shifted the decision-making to PDKT. Furthermore, increased tension/anxiety and depressive mood contributed to choosing PDKT, but increased confusion was dominantly observed in PEKT recipients. These direct impact factors for decision-making were secondarily regulated by the trait anxiety of the recipients. Unlike the recipients, the donors' QOL associated with vitality contributed to choosing PDKT, whereas the physical and mental health of the donors shifted the decision-making to PEKT. Interestingly, we also detected the typical features of PEKT donors, who showed higher tolerability against the trait anxiety of reactive tension/anxiety than PDKT donors. These results suggest that choosing between either PEKT or PDKT is likely achieved through the proactive support of family members as candidate donors, rather than the recipients. Furthermore, PDKT is possibly facilitated by an enrichment of the life-work-family balance of the donors. Therefore, multidisciplinary kidney teams should be aware of the familial psychodynamics between patients with ESRD and their family members during the shared decision-making process by continuing the educational consultation programmes for the kidney-replacement-therapy decision-making process.

Keywords: end-stage renal disease; kidney replacement therapy; life–work–family balance; preemptive kidney transplantation; quality of life.

Figure 1

Short Form-36 Health Survey version 2 (SF-36v2) scores (quality of life: QOL) of recipients (A,C) and donors (B,D) in preemptive kidney transplantation (PEKT: A,B) and post-dialysis kidney transplantation (PDKT: C,D). Ordinates indicate the mean ± SD of the scores of SF-36v2. Red lines indicate the lowest SF-36v2 scores among the healthy general Japanese population. SF-36v2 is composed of eight subscales—“physical functioning” (PF), “role physical” (RP), “bodily pain” (BP), “general health” (GH), “vitality” (VT), “social functioning” (SF), “role emotional” (RE) and “mental health” (MH)—and three QOL components: Physical (PCS), mental (MCS), and role social (RCS) components.

Figure 2

Comparisons of SF-36v2-PCS (A), SF-36v2-MCS (B), and SF-36v2-RSC (C) among PEKT recipients (PEKT-R), PDKT recipients (PDKT-R), PEKT donors (PEKT-D), and PDKT donors (PDKT-D) during kidney transplant decision-making. Ordinates indicate the mean ± SD for the scores of the SF-36v2 components. * p < 0.05, ** p < 0.01, relative to the SF-36v2 component scores of donors using a two-way analysis of variance (ANOVA) with Scheffe’s post-hoc test. Analyses between PEKT and PDKT were impossible since the F-values of the two-way ANOVA for the transplantation factor (PEKT vs. PDKT) and interaction factors (transplantation with relationship) were not violated (p > 0.05).

Figure 3

Scores for the Profile of Mood States (POMS) and State–Trait Anxiety Inventory (STAI) for the recipients (A,C) and donors (B,D) of PEKT (A,B) and PDKT (C,D). Ordinates indicate the mean ± SD of the scores of POMS and STAI. POMS is composed of 6 subscales: “tension/anxiety” (TA), “depression” (D), “anger/hostility” (AH), “vigour” (V), “fatigue” (F) and “confusion” (C). STAI is composed of two subscales: “state anxiety” (S) and “trait anxiety” (T).

Figure 4

Correlation between the POMS-TA and STAI-T of recipients (A) and donors (B). Blue and red circles indicate PEKT, and PDKT, respectively. Closed and opened circles indicate recipients and donors, respectively. Full and dotted lines indicate the regressions of recipients and donors, respectively. Ordinates and abscissas indicate the mean ± SD of the POMS-TA, and STAI-T scores, respectively.

Figure 5

Proposed cascades of decision-making processes for PEKT and PDKT.