Long-term adherence and health-related quality of life outcomes in kidney transplant recipients

Background: Kidney transplantation (KTx) is the optimal treatment for end-stage renal failure, improving survival and quality of life. However, graft and patient survival after KTx has decreased gradually over ten years. Aim: This study aimed to evaluate the long-term adaptation behavior and quality of life in KTx patients. Methods: This descriptive and correlational study included 101 KTx patients who underwent transplantation between 2003 and 2013 and had a follow-up period of at least ten years. Data were collected using the Basel Assessment of Adherence to Immunosuppressive Medications Scale (BAASIS©), the Skin Cancer and Sun Protection Behavior Questionnaire, the Adherence to Early Cancer Detection Recommendations Questionnaire, the Adherence to Clinical Follow-up Appointments Questionnaire, and the Short Form-36 (SF-36) Quality of Life Scale. Results: The mean age of KTx patients (n=101) was 49.90±11.03 years, with a mean post-transplant duration of 16.48±5.86 years. Non-adherence to immunosuppressive medication was observed in 40.59%, while 67.35% adhered to outpatient follow-up appointments. Adherence to cancer screening recommendations was 3.96%. Employed patients had lower medication adherence (MA) (X²=5.188, p<0.05). Skin cancer and sun protection behaviors were positively correlated with age, male gender, single status, employment, and higher education level. Adherence to outpatient visits decreased with time post-transplant (t=-3.48; p=0.001) but increased with higher MA (X²=8.337, p<0.005). Older age (β=-0.312; p=0.002), lower education (KW=11.815; p=0.003), and unemployment (U=380.00; p<0.001) were negatively associated with the physical health dimension of quality of life. Conclusions: Employed patients exhibited lower adherence to immunosuppressive medication. Sociodemographic factors, including younger age, male gender, single status, higher education level, and employment, were linked to lower adherence to skin cancer and sun protection measures. Adherence to outpatient follow-ups declined with increasing time post-transplantation. Furthermore, older age, lower education level, and unemployment negatively impacted the physical dimension of quality of life. Long-term KTx patients should receive comprehensive education on all cancer screening recommendations, with a particular emphasis on skin cancer prevention strategies.