title: Social participation after kidney transplantation as a predictor of graft loss and mortality over 10 years: a longitudinal study.
abstract: BACKGROUND
  Social participation is considered to be an objective parameter for evaluating the success of transplantation. This study explores the association between posttransplant factors (kidney function, perceived side effects of immunosuppressive treatment, comorbidity, physical and mental health-related quality of life [HRQoL]) and social participation in patients 3 months to 6 years after kidney transplantation (baseline) and their impact on graft loss and mortality for up to 10 years (follow-up).
  
  
  METHODS
  At baseline, 331 patients provided their socioeconomic and medical data (comorbidity, kidney function) and completed the end-stage renal disease symptom checklist (perceived side effects), the Short Form Health Survey-36 and the Participation Scale. At follow-up, information on all-cause graft-loss and mortality was noted. Binary logistical regression exploring the effects of the independent variables on social participation and Cox regression analyses determining whether social participation predicted graft loss and mortality were performed.
  
  
  RESULTS
  Restrictions in social participation were associated with living alone, poorer kidney function, lower perceived side effects of corticosteroids, higher perceived cardiac and renal dysfunction, higher perceived posttransplantation distress, lower physical HRQoL, and fewer working hours. Restrictions in social participation increased the risk of all-cause graft loss 2.29-fold and the risk of all-cause mortality 11.94-fold during follow-up. Education, kidney function, and comorbidity also increased the risk for poor patient outcome.
  
  
  CONCLUSIONS
  Kidney function, perceived side effects, comorbidities, and HRQoL affect social participation in patients after kidney transplantation. Additionally, social participation has a positive effect on long-term patient outcomes, decreasing the odds of graft loss and mortality over 10 years.
authors.affiliation: 1 Graduate School Kosice Institute for Society and Health, Faculty of Medicine, PJ Safarik University, Kosice, Slovak Republic. 2 Institute of Public Health, Department of Social Medicine, Faculty of Medicine, PJ Safarik University, Kosice, Slovak Republic. 3 Nephrology and Dialysis Centre Fresenius, Kosice, Slovak Republic. 4 Transplantation Department, University Hospital L. Pasteur, Kosice, Slovak Republic. 5 Department of Community and Occupational Health, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: Lucia
authors.initials: L
authors.lastname: Prihodova
authors.forename: Iveta
authors.initials: I
authors.lastname: Nagyova
authors.forename: Jaroslav
authors.initials: J
authors.lastname: Rosenberger
authors.forename: Robert
authors.initials: R
authors.lastname: Roland
authors.forename: Maria
authors.initials: M
authors.lastname: Majernikova
authors.forename: Johan W
authors.initials: JW
authors.lastname: Groothoff
authors.forename: Jitse P
authors.initials: JP
authors.lastname: van Dijk
mesh_terms: D000328:Adult; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007676:Kidney Failure, Chronic / Q000523:psychology / Q000601:surgery*; D016030:Kidney Transplantation; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D012919:Social Behavior; D012923:Social Class; D058992:Social Participation
chemical_list: D007166:Immunosuppressive Agents