Introduction: Our Сenter performed 716 kidney transplants (KTx) between April 1986 and January 2018. We evaluated the social aspects of long-term KTx outcomes for better understanding the tasks for professionals.
Materials and Methods: The median recipient age was 42.6 years with M:F ratio of 1.6:1. Hemodialysis was conducted 684 (95.5%) candidates, pre-emptive KTx were in 32 (4.5%) cases, from deceased donors were 516 (72.1%) KTx, from living donors - 200 (27.9%). ‘Custodiol HTK Solution’ was used for graft’s storage. Among all KTx we classified 98 as a high risk (childrens, diabetics, repeated transplants and other). After surgery modern standard immunosuppression spectrum was provided. We used SF-36 scale to assess patients’ quality of life.
Results and Discussion: One-year survival of high risk recipients was 95,9 %. The maximum term of satisfactory function of the kidney transplanted at our Center to 44-year-old patient with chronic glomerulonephritis is more than 28 years. Monitoring continues.
Long - term follow-up of recipients showed that the main clinical problems by the end of the first year after KTx are gradually resolved. Later, the importance of social rehabilitation increases and depends on the stability of renal graft function.
All patients with normal graft function showed that their quality of life changed for the better so much that it justified the most serious costs associated with the implementation of the transplant program. Satisfactory function of the renal graft allowed to continuing studies, work, sports and self-improvement. The fertility function was restored. Fears associated with living kidney donation were compensated by good health and great moral satisfaction of the donor and recipient after KTx. This strengthened not only family relations, but also contributed to the revision of many views on life in a positive direction. Patients who underwent kidney transplantation became more tolerant to social force majeure in comparison with healthy ones.
Most quality of life indicators of renal transplant recipients are lower than in healthy individuals, but much higher than in dialysis population. For example, the scale of "General Health" in healthy individuals was 73.2+6.2 points, in patients after transplantation – 60.5+6.1 points, in hemodialysis patients - 40.5+6.7 points. The ratio of married, working, having higher education among transplant recipients and dialysis patients with the same duration of treatment was respectively 1,3:1, 3.9:1 and 2.6:1. Motives, social obligations and educational level of recipients had sometimes a greater impact on therapeutic compliance than clinical features. In the later periods after transplantation, we did’nt observe noncompliance, because noncompliant patients loss transplants an earlier stage.
Conclusions: Long-term follow-up revealed a large and sometimes dominant influence of the social aspects on kidney graft and patient’s long-term survival.