Abstract
This three wave longitudinal study investigated perceived quality of life (QoL) among renal transplant recipients (RTRs) with healthy graft functioning across 15 months in Pakistan. The contribution of demographic, clinical and psychosocial factors in influencing QoL as a subjective construct was measured using QoL index-kidney transplant version. The four domains of QoL included; health functioning, family life, psychological and spiritual well-being and social/economic conditions. Most RTRs were moderately satisfied with their QoL. Being younger, male, married, in work and financially stable was related to higher levels of QoL satisfaction. The clinical factors including renal functions, and general health indicators neither influenced QoL nor any significant associations or causal relationships were found. Psychosocial variables included; depression levels, life orientation (optimism), perceived health status (PHS) and conscientiousness. Significant correlations among depression, PHS and life orientation and QoL were found except conscientiousness which was neither associated with QoL nor compliance as indicated by cyclosporine levels. A cross lagged correlation design (CLC) showed a lack of causal priority among depression, PHS, conscientiousness and QoL. However, a predominant causal flow was found among QoL and life orientation, reflecting that recipients with increased QoL satisfaction tend to be more optimistic. A qualitative study was included to support the quantitative data and compared recipients with highest and lowest scores on QoL index, who described their experiences of health and over all life pre-and post transplant. The themes included; individual differences in the impact of transplant on relationships with significant others, (family, work and social life) self-identity, social comparisons, perceptions of health care and medical professionals, adjustment, acceptance and coping with a transplant. The recipients with a positive perception in these aspects tend to be more satisfied with QoL. Some interesting conceptual issues regarding an overlap among QoL and psychosocial variables, questioned if these are distinct constructs.