Health-Related Quality of Life as an Early Indicator of Adverse Outcomes in Kidney Transplant Recipients

Abstract

Background: Health-related quality of life (HRQoL) may provide clinically relevant prognostic information beyond conventional measures of graft function in kidney transplant recipients. This study evaluated whether baseline HRQoL could identify recipients at increased risk of adverse outcomes.
Methods: A secondary observational cohort analysis was conducted among 156 kidney transplant recipients. HRQoL was assessed using the five EQ-5D-5L dimensions and a 0–100 self-assessment score. The primary composite outcome was death or return to dialysis. Group differences were evaluated using Mann–Whitney U, chi-square, or Fisher’s exact tests. Kaplan–Meier analysis, log-rank testing, Cox proportional-hazards regression, and receiver operating characteristic analysis were performed.
Results: Twenty-nine recipients (18.6%) experienced the composite outcome. Those with adverse outcomes had lower median self-assessment scores (60 vs. 80, p < .001), greater EQ-5D-5L severity, and more affected dimensions. Lower baseline HRQoL was associated with poorer adverse-outcome-free survival. In adjusted Cox analysis, each 10-point increase in self-assessment score was associated with a 24% lower hazard of adverse outcome (HR = 0.760, 95% CI 0.595–0.972). The combined predictive model achieved an AUC of 0.814.
Conclusion: Baseline HRQoL may complement clinical indicators for early risk stratification after kidney transplantation.