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(169) Evaluation of psychopathology, personality characteristics and quality of life in patients eligiblefor simultaneous pancreas and kidney transplantation


Authors:

Jacqueline Hovens, MD, PhD – Psychiatrist senior, LUMC

Abstract:

Simultaneous pancreas and kidney (SPK) transplantation is the only curative therapy for diabetic patients with end-stage renal disease (ESRD). Limited research has been done on the prevalence of psychopathology, personality characteristics and the quality of life in SPK transplantation recipients. The objective of this study was to evaluate the prevalence of psychopathology and to assess its potential influence on the quality of life in patients pre- and post SPK transplantation. In a national referral center in the Netherlands, we studied 47 patients on the waiting list for SPK transplantation, 72 post-SPK transplantation patients and a matched control group of 42 patients with type I diabetes mellitus without ESRD. Three self report questionnaires were administered: (1) the Brief Symptom Inventory (BSI) to assess psychopathology, reflecting DSM-IV axis I; (2) the Dimensional Assessment of Personality Pathology Short (DAPPs) to screen for personality pathology; and (3) the Short Form 36 (SF-36) to assess quality of life. Various somatic variables from chart review were taken into account. The groups were compared by analysis of variance for continuous variables and X2 – tests for categorical variables. Non-parametric test such as the Wilcoxon rank-sum test and the Kruskal-Wallis test were used for the DAPP-sf and BSI data. The pre-SPK transplantation patients were the youngest group (Table 1). The pre- and post-SPK transplantation patients had more diabetes-related complications than the type 1 diabetes group (p< 0.001), whereas the pre-and post-SPK groups did not differ, except for nephropathy (better post-SPK) and malignancies (worse post-SPK). No differences were found in personality characteristics, except for higher ‘submissiveness’ in type 1 diabetes (p=0.03). Quality of life on the dimension ‘general health’ was higher in the post-SPK transplant group than the pre-SPK transplant group (p=0.02), but the type 1 diabetes group showed the highest scores on both mental and physical domains of the SF-36 (Table 2). The pre-and post-SPK transplantation groups were not significantly different in psychopathology, but suffered more ‘somatization’ (both groups), ‘paranoid ideation’ (pre-SPK), ‘hostility’ and a higher total score (post-SPK), compared to the diabetic reference group (Table 3). There was a significant correlation between psychopathology (total score BSI) and quality of life (total score SF-36) in all studied subjects (r = -0.62).
Conclusion: The high prevalence of psychopathology in the pre- and post-SPK transplantation groups is likely to be associated with reduced quality of life in these patients. Although improved after SPK transplantation, quality of life does not reach the level of type 1 diabetes patients without ESRD.

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