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Marinela and Wim van den Heuvel

 
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SOCIAL PARTICIPATION AFTER KIDNEY TRANSPLANTATION

 

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This project was developed by Wim van den Heuvel and funded by the Netherlands Kidney Foundation. The background of the project is related with the experience of a friend, who had a lot of problems to be accepted in a new job and in life insurance after a successful kidney transplantation. The results of the study are published in international journals (see publications) and have resulted in a PhD thesis by Sijrike van der Mei, defended in Groningen 31 January 2007.

Successful kidney transplantation implies the transition from a life with the constraints imposed by dialysis to a “new” way of living. As quality of life increases after transplantation, recipients expect that social life returns to “normalcy” again. But this is not the case per se. Life after transplantation also has drawbacks, such as the strict immunosuppressive regimen and its side effects, frequent medical follow-up visits, rejection episodes, infections, and uncertainty and anxiety for potential graft loss.

In contrast with increased quality of life after kidney transplantation results concerning resumption of social life are less satisfactory. This study showed that transplant recipients participated less in employment and sports compared to the general population. Factors contributing to this impaired social participation are studied here too. Worse social outcome is related to cadaveric donation as compared to living donation, and for patients with cardiovascular disease. Post transplantation return to work is associated with employment status pre transplantation. From rehabilitation perspective, it is desirable to understand the process of social participation after transplantation and the factors associated. If factors appear to be amenable to change, this would offer opportunities for interventions in the rehabilitation process.

Also this project described prospectively changes in social participation in the first year after transplantation, focusing on the period of 3 months to well over 1 year after transplantation. Kidney transplantation enhances social participation of recipients in the first year post transplantation, not only in obligatory activities but in leisure activities as well. Employed recipients returned to work after initial sick leave. However, overall employment rate hardly increased and 47% of employed recipients were also work disabled. Additionally, pre-ESRD level of participation could not be regained and recipients experienced more limitations in fulfilling social roles due to physical health problems, compared with the general population.