Self-rated health and mortality after kidney transplantation

(2013) Maria Majernikova

Promotor: Prof. Dr. Johan W. Groothoff

Copromotor: Assoc. Prof. Dr. Jitse P. van Dijk, Dr. Jaroslav Rosenberger, Robert Roland, MD


Majernikova Thesis The study of Maria Majernikova, MD focuses on self-rated health (SRH), morbidity and mortality in kidney transplant (KT) recipients and shows the possibilities for SRH as a potential indicator of future health status after KT. We found the change in graft function over time to be a significant predictor of SRH at one-year follow-up after KT and at longer follow-up. Medical factors, such as late acute rejection episodes, chronic renal allograft dysfunction and post-transplant anemia, were found to be independent predictors of SRH worsening at different times after transplantation, depending on the stage of Chronic Kidney Disease (CKD). Previously, mild and severe anemia during the first year after KT were found to be a predictor of patient mortality independently of kidney function in patients with CKD stages 1-2; on the other hand, severe – but not mild – anemia increased mortality risk in transplanted patients with CKD stages 3-5. Moreover, SRH at early time after transplantation was shown to be an independent predictor of a patient’s mortality and graft loss. We found that average SRH was associated with a 4-fold higher and poor SRH with an 11-fold higher risk of mortality at up to ten years follow-up. Up to now, average SRH has been associated with a 3-fold higher risk of graft loss and poor SRH with a 6-fold higher risk of graft loss at up to ten years follow-up. Improving long-term post-transplantation outcomes should be a priority for the management of transplanted recipients in order to reduce the risk of morbidity and mortality.