NEW YORK (Reuters Health) - Five years after kidney transplantation, a significant number of patients have sexual problems, headaches, and other ailments that adversely affect their quality of life (QOL), study results suggest.

QOL issues have been "previously underemphasized in transplant recipients," Dr. Arthur J. Matas, director of renal transplantation at the University of Minnesota, and a multicenter team note in the April issue of Clinical Transplantation.

They analyzed questionnaires completed at 3-month intervals by 4247 renal transplant recipients participating in a program designed to improve QOL and preserve graft function. Patients were, on average, 51 years old at the time of their transplant and were in their 5th posttransplant year. Over 95% were taking steroids at entry into the program.

Decreased sexual interest or ability emerged as the strongest correlate of decreased QOL on the life satisfaction index, the team reports. More than 60% of patients reported sexual problems sometimes, often, or always at baseline. Moreover, among 598 subjects who completed six questionnaires over a period of18 months, the prevalence of sexual problems did not decline appreciably.

"These results confirm other reports of major sexual dysfunction in 25% to 50% of renal transplant recipients," the team notes. The fact that patients were 5 years from transplant also indicates that sexual problems are not "simply a residual of pretransplant sexual deficits associated with the uremia of end-stage renal disease," they add.

Headaches, while "infrequently" mentioned in the transplant literature as a clinically significant problem, had almost as strong an effect on QOL as did sexual problems, the team reports. Headaches had a greater impact on QOL than more commonly discussed adverse effects such as body and facial shape changes, swelling of the extremities, and easy bruisability.

Comorbidities were also quite common, the authors say, with 87%, 70%, and 53% of patients reporting hypertension, unusual hair growth, and hypercholesterolemia, respectively. Joint problems, diabetes, and eye disease were each reported by about 30% of subjects and heart disease by about 25%. Despite a "relatively low" 13% prevalence, emotional and psychological problems had the most significant effect of any comorbid condition, the team reports.

Based on their study, Dr. Matas and colleagues recommend that physicians "actively solicit" information about sexual and relationship issues when evaluating renal transplant patients.

Clin Transplant 2002;16:113-121.

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