Reasons for Refusing Kidney Transplantation Among Chronic Dialysis Patients

Abstract

The aim of the prospective clinical study was to evaluate the reasons for refusing kidney transplantation among chronic dialysis patients. A total of 164 adult chronic dialysis patients participated in the study. They were asked to complete a detailed questionnaire on specific issues regarding transplantation. The mean age was 60.9 ± 16.0 (20-89) years, 61.6% were male, 11.6% had had a previous transplant. The majority, that is, 72.0%, of the patients believed that transplantation improved the quality of life, and 55.5% believed that transplantation prolonged life. Nevertheless, 45.0% of the patients wanted to be transplanted, 35.0% refused transplantation, and 20.0% were undecided. Patients refusing transplantation were significantly older compared to the patients wanting to be transplanted (67 ± 16 vs. 57 ± 16 years; P < 0.001). The main reasons for refusing transplantation (57 patients) were the side-effects of immunosuppressive therapy (31.6%), unpredictability of transplant outcome (29.8%), and unfavorable outcomes in fellow patients (28.1%). The side-effects of immunosuppressive therapy that patients were most concerned about included mobility problems (29.8%), new-onset diabetes (26.3%), increased risk of severe infections (26.3%), problems with vision (22.8%), and increased risk of cancer (21.1%). Many patients did not want to accept organs from expanded criteria donors (ECD) (44.6% of the patients wanting and 64.9% of those refusing transplantation). The majority believed that patients should be informed if an organ from an ECD donor is being offered (64.9% of patients wanting and 63.2% of those refusing transplantation). The main reasons for refusing kidney transplantation were the side-effects of immunosuppressive therapy, unpredictability of transplant outcome, and unfavorable outcomes in fellow patients.

Why Did Sudanese End Stage Renal Failure Patients Refuse Renal Transplantation?

“…As has been shown before in previous study, age was a factor in refusal of renal transplantation [5]. Patients who are employed tend to accept renal transplantation.…”

“…In contrast, other study reported that side effects of immunosuppressive medications are a major reason behind refusal of renal transplantation among ESRF patients [5].…”

Adherence Factors Affecting Kidney Transplant Recipient among Patients on Maintenance Haemodialysis in C&#244;te d’Ivoire

“…The relative young age of applicants for kidney transplantation was also mentioned by other authors [10] [21]. Patients on dialysis for long period were willing to kidney transplantation.…”

“…While the results of the western studies explain the rejection of kidney transplantation by the fear of the immunosuppression and uncertainty related to the development of the transplantation [10], or a previous personal or somebody else bad experience [21], our patients lay the emphasis upon the high cost of the transplantation. The high cost of kidney transplantation compared to dialysis was also mentioned by patients in other African countries [12] [15] [16], China [9] and in the African American community [11] of USA.…”

“…In our study the rate of patient rejecting kidney transplantation was estimated at 21.69%. In other studies, this rate varies from 13.7% to 35% [10] [12] [19]. According to Pradel [20], the setting up of a patient education program for the promotion of kidney transplantation may be necessary to improve treatment compliance.…”