title: Effect of tolerance versus chronic immunosuppression protocols on the quality of life of kidney transplant recipients.
abstract: BACKGROUND
  Kidney transplant patients on tolerance protocols avoid the morbidity associated with the use of conventional chronic immunosuppressive regimens. However, the impact of tolerance versus conventional regimens on the quality of life (QOL) of kidney transplant patients is unknown.
  
  
  METHODS
  Five patients who achieved long-term immunosuppression-free renal allograft survival after combined kidney and bone marrow transplantation (tolerant group) were compared with thirty-two comparable kidney transplant recipients on conventional immunosuppression (conventional group). QOL was compared with 16 conventional recipients using the Kidney Disease Quality of Life Short Form 36 (KDQOL SF-36) and the Modified Transplant Symptom Occurrence and Symptom Distress Scale (MTSOSD-59R).
  
  
  RESULTS
  Patients in the tolerant group required significantly less treatment after transplant for hypertension and no medications for diabetes (P< 0.01). There was no incidence of diabetes, dyslipidemia, or malignancies in the tolerant group, while these were observed in 12.5%, 40.6%, and 11.8% of the conventional group, respectively. Tolerant patients experienced better overall health (P< 0.01) and scored higher on kidney transplant-targeted scales and healthy survey scales than patients in the conventional group according to the KDQOL SF-36 (P< 0.05). Tolerant patients were less likely to experience depression, dyspnea, excessive appetite/thirst, flatulence, hearing loss, itching, joint pain, lack of energy, muscle cramps, and lack of libido than conventional patients according to the MTSOSD-59R (P< 0.05).
  
  
  CONCLUSIONS
  Kidney transplant recipients who achieved tolerance experience significantly fewer incidences of complications, improved QOL, and fewer comorbid symptoms compared with patients on conventional immunosuppression. These results support the expanded use of tolerance protocols in kidney transplantation.
authors.affiliation: Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA.
authors.forename: Maria Lucia L
authors.initials: ML
authors.lastname: Madariaga
authors.affiliation: Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA.
authors.forename: Philip J
authors.initials: PJ
authors.lastname: Spencer
authors.affiliation: Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA.
authors.forename: Kumaran
authors.initials: K
authors.lastname: Shanmugarajah
authors.affiliation: Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA.
authors.forename: Kerry A
authors.initials: KA
authors.lastname: Crisalli
authors.affiliation: Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA.
authors.forename: David C
authors.initials: DC
authors.lastname: Chang
authors.affiliation: Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA.
authors.forename: James F
authors.initials: JF
authors.lastname: Markmann
authors.affiliation: Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA.
authors.forename: Nahel
authors.initials: N
authors.lastname: Elias
authors.affiliation: Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA.
authors.forename: A Benedict
authors.initials: AB
authors.lastname: Cosimi
authors.affiliation: Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA.
authors.forename: David H
authors.initials: DH
authors.lastname: Sachs
authors.affiliation: Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA.
authors.forename: Tatsuo
authors.initials: T
authors.lastname: Kawai