title: Perspectives of Older Kidney Transplant Recipients on Kidney Transplantation.
abstract: OBJECTIVE
  Older kidney transplant recipients are susceptible to cognitive impairment, frailty, comorbidities, immunosuppression-related complications, and chronic graft failure, however, there has been limited focus on their concerns and expectations related to transplantation. This study aims to describe the perspectives of older kidney transplant recipients about their experience of kidney transplantation, self-management, and treatment goals to inform strategies and interventions that address their specific needs.
  
  
  METHODS
  Face-to-face semistructured interviews were conducted with 30 kidney transplant recipients aged 65-80 years from five renal units in Australia. Transcripts were analyzed thematically.
  
  
  RESULTS
  Six themes were identified: restoring vitality of youth (with subthemes of revived mindset for resilience, embracing enjoyment in life, drive for self-actualization); persisting through prolonged recovery (yielding to aging, accepting functional limitations, pushing the limit, enduring treatment responsibilities); imposing sicknesses (combatting devastating comorbidities, painful restrictions, emerging disillusionment, anxieties about accumulating side effects, consuming treatment burden); prioritizing graft survival (privileged with a miracle, negotiating risks for longevity, enacting a moral duty, preserving the last opportunity); confronting health deterioration (vulnerability and helplessness, narrowing focus to immediate concerns, uncertainty of survival); and value of existence (purpose through autonomy, refusing the burden of futile treatment, staying alive by all means).
  
  
  CONCLUSIONS
  Older kidney transplant recipients felt able to enjoy life and strived to live at their newly re-established potential and capability, which motivated them to protect their graft. However, some felt constrained by slow recuperation and overwhelmed by unexpected comorbidities, medication-related side effects, and health decline. Our findings suggest the need to prepare and support older recipients for self-management responsibilities, clarify their expectations of post-transplant risks and outcomes, and provide assistance through prolonged recovery after kidney transplantation.
authors.affiliation: Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia.|Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, New South Wales, Australia.|Department of Medicine, Division of Nephrology, Würzburg University Clinic, Würzburg, Germany.
authors.forename: Jule
authors.initials: J
authors.lastname: Pinter
authors.affiliation: Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia.|Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, New South Wales, Australia.
authors.forename: Camilla S
authors.initials: CS
authors.lastname: Hanson
authors.affiliation: Centre for Transplant and Renal Research, Westmead Hospital, Westmead, New South Wales, Australia; and.
authors.forename: Jeremy R
authors.initials: JR
authors.lastname: Chapman
authors.affiliation: Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia.|Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, New South Wales, Australia.|Centre for Transplant and Renal Research, Westmead Hospital, Westmead, New South Wales, Australia; and.
authors.forename: Germaine
authors.initials: G
authors.lastname: Wong
authors.affiliation: Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia.|Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, New South Wales, Australia.
authors.forename: Jonathan C
authors.initials: JC
authors.lastname: Craig
authors.affiliation: Section of Palliative Care and Medical Ethics, Renal-Electrolyte Division, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Jane O
authors.initials: JO
authors.lastname: Schell
authors.affiliation: Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia.|Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, New South Wales, Australia.
authors.forename: Allison
authors.initials: A
authors.lastname: Tong
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000523:psychology*; D015897:Comorbidity; D005260:Female; D006085:Graft Survival; D006801:Humans; D007407:Interviews as Topic; D016030:Kidney Transplantation / Q000009:adverse effects / Q000523:psychology*; D008297:Male; D010347:Patient Care Planning; D036301:Qualitative Research; D055500:Resilience, Psychological; D012648:Self Care; D020377:Self Efficacy; D066027:Transplant Recipients / Q000523:psychology*; D035501:Uncertainty
keywords: Australia; adolescent; aging; anxiety; cognition disorders; comorbidity; geriatric nephrology; goals; graft survival; humans; immunosuppression; kidney transplantation; longevity; medical futility; moral obligations; motivation; negotiating; quality of life; self-care; transplant outcomes; transplant recipients; uncertainty