Kidney Week

Abstract: SA-PO030

Fatigue Predicts Graft and Patient Survival After Kidney Transplant

Session Information

• Transplantation: Clinical Outcomes
  October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Transplantation

• 1802 Transplantation: Clinical

Authors

• Peipert, John D., Northwestern University, Chicago, Illinois, United States

John D. Peipert,

• Caicedo, Juan Carlos, Northwestern University, Chicago, Illinois, United States

Juan Carlos Caicedo,

• Ensor, Kelsey Lee, Northwestern University, Chicago, Illinois, United States

Kelsey Lee Ensor,

• Cella, David, Northwestern University, Chicago, Illinois, United States

David Cella,

• Friedewald, John J., Northwestern University, Chicago, Illinois, United States

John J. Friedewald,

• Abecassis, Michael, Northwestern University, Chicago, Illinois, United States

Michael Abecassis,

• Ladner, Daniela, Northwestern University, Chicago, Illinois, United States

Daniela Ladner,

• Butt, Zeeshan, Northwestern University, Chicago, Illinois, United States

Zeeshan Butt,

Group or Team Name

• Northwestern University Transplant Outcomes Research Collaborative-NUTORC

Background

Fatigue is a prevalent post- kidney transplant (KT) symptom, and it is associated with reduced overall health-related quality of life and decreased kidney function. Yet, its association with graft and patient survival is unclear.

Methods

Using the SF-36 Vitality (Vit) scale and a single question from the Functional Assessment of Cancer Therapy – Kidney Symptom Index, “I have a lack of energy” (GP1), we examined change in fatigue from pre- and post-KT (3 months and 1 year) among 528 KT patients between 10/29/2007 and 08/18/2016 at a large academic transplant center. The Vit scale ranges from 0-100, and GP1 ranges from 0-4. On both measures, higher scores indicate less fatigue. We examined whether pre-KT fatigue and slope of change in fatigue from pre- to post-KT were associated with 1- and 3-year death censored graft survival (DCGS) and patient survival.

Results

Respectively, mean Vit and GP5 scores increased from pre-KT to 3 mo and 1 year post-KT: Vit - 45.4, 63.5, 67.3 (p<0.001); GP1 – 1.8, 2.7, 2.9 (p<0.001). There was a significant association with change in creatinine from pre- to post-KT with fatigue measured by both the Vit and GP1 (p<0.001 for each). Patients with median or below Vit scores pre-KT had significantly lower 1 year DCGS rates (93.2% vs. 96.9%, p=0.045) and patient survival rates (96.2% vs. 99.6%, p=0.006). Patients with median or below slope in Vit score change from pre- to post-KT had lower 3 year DCGS rates (88.5% vs. 96.2%, p=0.002) (Figure). Similar to these results, patients with median or below slope in GP1 score change from pre- to post-KT had lower 3 year DCGS rates (88.8% vs. 94.6%, p=0.04).

Conclusion

Fatigue is associated with reduced kidney function, graft failure, and mortality after KT. Patients with high risk for graft loss and mortality also suffer from higher fatigue after KT than those with well working kidneys. Future research should explore how monitoring fatigue might improve post-KT follow-up.