Impact of transplantation on quality of life in patients with diabetes andrenal dysfunction

Background Simultaneous pancreas/kidney transplant (SPK) is an effective th erapy that enables people with insulin-dependent diabetes mellitus (IDDM) a nd renal failure to maintain a more normal lifestyle, without the burdens o f dialysis and insulin therapy, How ever, SPK has been viewed as a higher c ost and higher risk procedure than kidney transplant, and it is unclear if SPK offers better health and quality of life (QOL) outcomes than insulin th erapy plus kidney transplant alone (RTA), The purpose of this study is to d etermine which procedure affords better health and QOL outcomes. Methods. This is a prospective observational study with assessments at pret ransplant and 1 and 3 years posttransplant. Patients with IDDM and renal dy sfunction who received either SPK or KTA from August 1990 to September 1993 at a university transplant center were enrolled. A convenience sample of p atients with IDDM and complications not seeking transplants were enrolled d uring the same time interval. The main outcome measures were the SF-36 Shor t Form Health Survey and a Satisfaction with Diabetes Therapy Scale. Results. Most health status and QOL measures improved from baseline values within each transplant group. After adjustment for diabetes severity and ot her baseline variables, year 3 follow-up scores of the SPK cohort were bett er than those of the RTA cohort for several SF-36 scales physical functioni ng (P=0.038); bodily pain (P=0.047), general health (P=0.014), and the phys ical component summary (P=0.003), SPK recipients also reported greater sati sfaction with diabetes therapy (P=0.014) and perceived more benefits to sec ondary complications, The RTA patients, however, had higher adjusted scores for the role-emotional subscale (P=.037) and the mental component summary (P=.037), By year 3, the SPK cohort is at the 30th and 51st percentiles of the general adult US population in self-reported physical and mental health ; the KTA cohort is at the 10th and 73rd percentiles Conclusions. At follow-up, both SPK and KTA patients report better health a nd quality of life but SPK patients report greater improvements than RTA pa tients in physical health and in areas that are diabetes specific, Although the improved physical outcomes of SPK patients are consistent with perceiv ed benefits to secondary complications, the mental health differences canno t be explained by the study data and warrant further study.