Evaluation of the quality of life of patients with insulin-dependent diabetes mellitus before and after organ transplantation with the SF 36 health survey

Abstract

Objective: To find out if patients with insulin-dependent diabetes mellitus who had undergone successful pancreas and kidney transplantation thought that their quality of life was better than that of patients before transplantation or patients who had rejected the grafts.

Design: Cross-sectional study.

Setting: Teaching hospital, Germany.

Subjects: 110 of 143 patients to whom questionnaires had been sent. Patients were divided into those awaiting transplantation who did not require dialysis (n = 9), those awaiting transplantation who were receiving dialysis (n = 27), those with functioning grafts after transplantation (n = 34), those with functioning kidneys taking insulin (n = 34); and those who had rejected both grafts and were being treated with both dialysis and insulin (n = 6).

Interventions: Short Form (SF) 36 health survey and two visual analogue scales.

Main outcome measures: Comparison of quality of life scores.

Results: The duration of dialysis before transplantation was the only feature that differed significantly between the responders (median 24 (range 0-133) months) compared with the non-responders (16 (0-70) months), p < 0.01. The psychometric quality of the SF 36 yielded good variance and reliability in the subscales, and excellent "scale fit" values (between 90% and 100%). Patients who had undergone successful transplantation scored significantly higher than those who had rejected their pancreatic graft in the subscales "vitality" (mean (SD) transformed score 64.4 (15.2) compared with 55.5 (18.9), p < 0.05), and "general health perception" (60.8(18.2) compared with 50.2 (22.5), p < 0.05). The worst ratings of quality of life were given by patients awaiting transplantation (whether or not they were being dialysed) and those who had rejected both grafts.

Conclusions: The SF 36 health survey is a valid instrument for testing patients' perceptions of outcome after transplantation. Those patients who had undergone successful pancreas and kidney transplantation gave the highest scores.