title: Increased prevalence of gastrointestinal symptoms associated with impaired quality of life in renal transplant recipients.
abstract: BACKGROUND
  Immunosuppressive therapies have been associated with gastrointestinal (GI) side effects, which may impair health-related quality of life (HRQoL).
  
  
  METHODS
  In this survey, 4,232 renal transplant recipients from Denmark, Finland, Norway, and Sweden completed the Short-Form 36 (SF-36) questionnaire and the Gastrointestinal Symptom Rating Scale (GSRS). SF-36 scores were compared with country norm values. Multiple logistic regression analysis was used to identify immunosuppressants associated with GI symptoms.
  
  
  RESULTS
  The prevalence of troublesome GI symptoms (GSRS>1) was 83% for indigestion, 69% for abdominal pain, 58% for constipation, 53% for diarrhea, 47% for reflux, and 92% for any GI symptom. Compared with the general population, HRQoL was most commonly meaningfully impaired in the general health dimension (53% of patients). The presence and severity of GI symptoms were associated with worse HRQoL. Tacrolimus showed a significant association with diarrhea (odds ratio [OR]: 1.7; 95% confidence interval [CI]: 1.4-2.0) and constipation (OR: 1.3; 95% CI: 1.1-1.6), and sirolimus with indigestion (OR: 2.9; 95% CI: 1.0-8.1) and abdominal pain (OR: 2.2; 95% CI: 1.1-4.4).
  
  
  CONCLUSIONS
  GI symptoms are associated with impaired HRQoL in the renal transplant population. Managing GI symptoms by careful choice of immunosuppressants should be a focus for improving HRQoL in renal transplant recipients.
authors.affiliation: Department of Nephrology and Transplantation, Malmö University Hospital, Lund University, Malmö, Sweden. henrik.ekberg@med.lu.se
authors.forename: Henrik
authors.initials: H
authors.lastname: Ekberg
authors.forename: Lauri
authors.initials: L
authors.lastname: Kyllönen
authors.forename: Søren
authors.initials: S
authors.lastname: Madsen
authors.forename: Gisle
authors.initials: G
authors.lastname: Grave
authors.forename: Dag
authors.initials: D
authors.lastname: Solbu
authors.forename: Hallvard
authors.initials: H
authors.lastname: Holdaas
mesh_terms: D000328:Adult; D005260:Female; D005767:Gastrointestinal Diseases / Q000453:epidemiology*; D006801:Humans; D007165:Immunosuppression Therapy / Q000009:adverse effects; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011788:Quality of Life; D011795:Surveys and Questionnaires
chemical_list: D007166:Immunosuppressive Agents