MP333
THE EFFECTS OF KIDNEY ALONE OR SIMULTANEOUS PANCREAS AND KIDNEY TRANSPLANT ON QUALITY OF LIFE AND HEALTH STATUS: FINDINGS FROM ATTOM PROGRAMME COHORTS WITH BASELINE DATA

Introduction and Aims: Researchers often misinterpret data from the EQ-5D and other health status (HS) tools as if they were measuring quality of life (QoL). We investigated both QoL and HS in patients with pre-and post-transplant measures as well as in wait-listed patients.

Methods: A sub-study of ATTOM measured QoL and HS in patients with stage 4/5 chronic kidney disease, including patients who received or were wait-listed for Kidney Alone (KA) or Simultaneous Pancreas + Kidney (SPK) transplant. 138 patients awaiting KA & 41 patients awaiting SPK transplant were recruited, of whom 40 & 22 patients respectively received transplants within 1yr. All 179 patients completed the EQ-5D HS measure (Visual Analogue Scale (VAS) rating & 5 dimensions with 5 levels) at recruitment & the Renal-Dependent Quality of Life (RDQoL) 3m post-recruitment. The 117 patients still wait-listed completed all measures again 12m post-recruitment as did the 62 KA/SPK recipients 12m post-transplant. Utility values were calculated by converting patient responses to the EQ-5D 5 dimensions using the 2014 health-state value set for England; scores range from 1 (perfect health) through 0 (death). Patients rate the VAS from 100 (best health) to 0 (worst). Patients’ RDQoL impact & importance ratings for the various aspects of life combine to give an average weighted impact (AWI) score (-9 most negative impact of renal condition on QoL, through 0 to +3 most positive impact). 2x2 mixed ANOVAs & 1-way ANCOVAs assessed differences in within/between transplant groups & their respective wait-listed groups.

Results: EQ-5D utility scores suggested better health at recruitment in KA recipients (M=0.87) compared with those awaiting KA (M=0.77; p=0.009). SPK recipients showed a similar trend to better baseline utility scores than those waitlisted (p=0.076). Baseline EQ-5D VAS and RDQoL AWI scores did not differ between those receiving KA or SPK transplants & their respective wait-list groups. RDQoL AWI scores improved in KA and SPK recipients but remained stable or deteriorated in those wait-listed (p<0.05). 72% KA and 75% SPK patients showed reduced negative impact of renal condition on QoL post-transplant, but 10% had greater negative impact on QoL. VAS health ratings improved following KA/SPK transplant but deteriorated in those wait-listed (p<0.001). Controlling for baseline scores, there was a trend for better health in KA recipients at 1yr (M=0.79) compared with those wait-listed (M=0.72; p=0.068), but both groups showed worsening utility scores over time (M=0.82 to M=0.77; p=0.003). Neither SPK recipients nor wait-list patients had changes in utility scores.

Conclusions: Surprisingly, EQ-5D utility scores suggested a deterioration in health status in both KA transplant & waiting patients with no change in SPK transplant recipients or those awaiting SPK while the VAS ratings showed the expected health improvement following transplantation. Renal-related QoL improved 1yr post-KA/SPK transplantation, compared with pre-transplant or with those still waitlisted.