Factors Explaining Quality of Life in People with Kidney Transplant: A Cross-sectional Study

Main Article Content

Lalida Noppakun
Tipaporn Wonghongkul
Linchong Pothiban
Nuttamon Vuttanon


          Kidney transplant is a critical treatment option for people with end-stage renal disease. Both the disease and transplant therapy usually reduce people’s quality of life. Understanding quality of life and its explaining factors is necessary to design effective intervention. Guided by The Common-Sense Model of Illness Representations, this cross-sectional study aimed to examine whether illness representations and self-management can explain quality of life among people with kidney transplant. Illness representations are people’s beliefs and expectations about their illness. Purposive sampling was used to recruit 207 participants with kidney transplant who attended a kidney transplant clinic at a tertiary hospital in northern Thailand. Instruments used were the Demographic and Clinical Data Form, the Revised Illness Perception Questionnaire, the Self-Management Scale for Kidney Transplant Recipients, and the Kidney Disease Quality of Life Short Form. Data were analyzed using descriptive statistics, Pearson’s correlation coefficient, and hierarchical regression analysis.

          Findings indicated that all dimensions of illness representations except the agreement with the reasons as causes for symptom had a significant and negative association with quality of life. Symptom experience, controlling of health threat, emotional representations of illness and self-management together significantly explained 33% of the variance in quality of life. However, this study should be further tested for the effectiveness through experimental design with people in different locations before implementation in practice. Nurses need to implement interventions to enhance quality of life in people with kidney transplant through designing interventions to support self-management to reduce symptoms of disease, positivity in controlling the health threat, and reduce the negative emotional representations of illness.


Article Details

How to Cite
Noppakun L, Wonghongkul T, Pothiban L, Vuttanon N. Factors Explaining Quality of Life in People with Kidney Transplant: A Cross-sectional Study. PRIJNR [Internet]. 2022 Mar. 5 [cited 2022 Aug. 9];26(2):198-211. Available from: https://he02.tci-thaijo.org/index.php/PRIJNR/article/view/256506
Original paper


Statista. Estimated number of worldwide kidney transplants in 2018, by region. [Internet]. 2021 June 1 [cited 2021 June 1]. Available from: https://www.statista.com/statistics/398657/kidney-transplants-by-world-region/

Thai Red Cross Organ Donation Centre. Annual report 2020 organ donation in Thailand. [Internet]. 2021 June 15 [cited 2021 June 15]. Available from: https://www.organdonate.in.th/assets/files/odc2563.pdf

Thai Transplantation Society. Annual report 2020 organ transplantation in Thailand. [Internet]. 2021 January 23 [cited 2021 January 23]. Available from: http://www.transplantthai.org/upload/editor/file/Registry%20book-62Final(2).pdf

Rangaswami J, Mathew RO, Parasuraman R, Tantisattamo E, Lubetzky M, Rao S, et al. Cardiovascular disease in the kidney transplant recipient: epidemiology, diagnosis and management strategies. Nephrol Dial Transplant. 2019;34:760-73. doi:10.1093/ndt/gfz053.

Frohlich FA, Halleck F, Lehner L, Schrezenmeier EV, Naik M, Schmidt D, et al. De-novo malignancies after kidney transplantation: a long-term observational study. PLoS One. 2020;15(11):e0242805. https://doi.org/10.1371/journal.pone.0242805

Bahrami A, Shams SF, Eidgahi ES, Lotfi Z, Sheikhi M, Shakeri S. Epidemiology of infectious complications in renal allograft recipients in the first year after transplant. Exp Clin Transplant. 2017;6:631-5. doi:10.6002/ect.2016.0068.

Infante B, Rossini M, Leo S, Troise D, Netti GS, Ranieri E, et al. Recurrent glomerulonephritis after renal transplantation: the clinical problem. Int J Mol Sci. 2020;21:5954. doi:10.3390/ijms21175954.

Sosa Pena M, Lopez-Soler R, Melendez JA. Senescence in chronic allograft nephropathy. Am J Physiol Renal Physiol. 2018;315:F880-9. doi:10.1152/ajprenal.00195.2016.

Rocha FL, Echevarria-Guanilo ME, Silva DMGV, Goncalves N, Lopes SGR, Boell JEW, et al. Relationship between quality of life, self-esteem and depression in people after kidney transplantation. Rev Bras Enferm. 2020;73(1):e20180245. http://dx.doi.org/10.1590/0034-7167-2018-0245

Di Matteo G, De Figlio A, Pietrangelo T. The psychological dimension of organ transplant patients: mini review. Med Case Rep Rev. 2018;1(2):1-4. doi:10.15761/MCRR. 1000111.

Leventhal H, Leventhal EA, Breland JY. Cognitive science speaks to the “Common-Sense” of chronic illness management. Ann Behav Med. 2011;41:152-63. doi:10.1007/s12160-010-9246-9.

Leventhal H, Brissette I, Leventhal EA. The common-sense model of self-regulation of health and illness. 2003. In: Cameron LD, Leventhal H, editors. The self-regulation of health and illness behaviour. London: Routledge Taylor & Francis Group; 2003. pp. 42-65.

Leventhal H, Meyer D, Nerenz D. The common sense representation of illness danger. 1980. In: Rachman S, editor. Contributions to medical psychology. New York:Pergamon Press; 1980. pp. 7-30.

Kosaka S, Tanaka M, Sakai T, Tomikawa S, Yoshida K, Chikaraishi T, et al. Development of self-management scale for kidney transplant recipients, including management of post-transplantation chronic kidney disease. ISRN Transplantation. 2013:1-7. http://dx.doi.org/10.5402/


World Health Organization. WHOQOL: measuring quality of life. [Internet]. 2021 June 1 [cited 2021 June 1]. Available from: https://www.who.int/tools/whoqol

Kostro JZ, Hellmann A, Kobiela J, Skora I, Lichodziejewska- Niemierko M, Debska-Slizien A, et al. Quality of life after kidney transplantation: a prospective study. Transplantation Proceedings. 2016;48:50-4. http://dx.doi.org/10.1016/j.transproceed.2015.10.058

Hays RD, Kallich JD, Mapes DL, Coons SJ, Amin N, Carter WB, et al. Kidney disease quality of life short form (KDQOL-SFTM), version 1.3: a manual for use and scoring. Santa Monica, CA: RAND, 1997.

El Rasheed AH, Khedr E, Naguib R, Eid M, Elkholy H, Rabie S. Quality of life in a sample of Egyptian renal transplant recipients. Middle East Current Psych. 2020; 27:31.https://doi.org/10.1186/s43045-020-00041-0

Mouelhi Y, Jouve E, Alessandrini M, Pedinielli N, Moal V, Meurette A., et al. Factors associated with health-related quality of life in kidney transplant recipients in France.BMC Nephrol. 2018;19:99. https://doi.org/10.1186/s12882-018-0893-6

Ware JE, Richardson MM, Meyer KB, Gandek B. Improving CKD-specific patient-reported measures of health-related quality of life. J Am Soc Nephrol. 2019;30(4):664-77. https://doi.org/10.1681/ASN.2018080814

Ranabhat K, Khanal P, Mishra SR, Khanal A, Tripathi S, Sigdel MR. Health related quality of life among haemodialysis and kidney transplant recipients from Nepal: a cross sectional study using WHOQOL-BREF. BMC Nephrol. 2020;21:433. https://doi.org/10.1186/s12882-020-02085-0

Antunes AV, Sousa LMM, Justo C, Ferrer J, Frade F, Severino SSP, et al. Assessment of the perceived quality of life of a kidney transplant patient. Enferm Nefrol. 2018;21(2):138-44. http://dx.doi.org/10.4321/s2254-28842018000200005

Dweib K, Jumaa S, Khdour M, Hallak H. Quality of life for kidney transplant Palestinian patients. Saudi J Kidney Dis Transpl. 2020;31(2):473-81.

Pragodpol P, Chanpen U, Kaewyota K. Factors related to self-management and quality of life among chronic illness patients living in a municipal area. J of Health and Nurs Educ. 2021;27(1):151-65 (in Thai).

Pratama VHK, Shahab A, Parisa N. The association between self management and quality of life type 2 diabetes mellitus patient in RSUP Dr. Mohammad Hoesin Palembang. Majalah Kedokteran Sriwijaya. 2019;51(2):107-11.

Zhang Y, Yan F, Jiang W. Relationship between selfmanagement behaviors and health-related quality of life among Chinese patients with coronary heart disease: a cross-sectional study. Contemp Nurse. 2019;55(6): 554-64. https://doi.org/10.1080/10376178.2020.1731316

Bringsvor HB, Langeland E, Oftedal BF, Skaug K, Assmus J, Bentsen SB. Self-management and health related quality of life in persons with chronic obstructive pulmonary disease. Qual of Life Research. 2019;28:2889-99. https://doi.org/10.1007/s11136-019-02231-8

Cha J. Structural equation modeling of self-management in patients with hemodialysis. J Korean Acad Nurs. 2017;47(1):14-24. https://doi.org/10.4040/jkan.2017.47.1.14

Vinaccia S, Quiceno JM, Lozano F, Romero S. Health-related quality of life, illness perception, happiness and negative emotions in rheumatoid arthritis patients. Acta Colomb Psicol. 2017;20(1):60-9. doi:10.14718/ACP.2017. 20.1.4.

Nabolsi MM, Wardam L, Al‐Halabi JO. Quality of life, depression, adherence to treatment and illness perception of patients on haemodialysis. Int J Nurs Pract. 2015;21:1-10. doi:10.1111/ijn.12205.

Alharbi AA, Alharbi YA, Alsobhi AS, Alharbi MA, Alharbi MA , Aljohani AA., et al. Impact of illness perception on the health-related quality of life of patients receiving dialysis: a cross-sectional study. Cureus. 2021; 13(6):e15705. doi:10.7759/cureus.15705.

Chen Yu-Chun, Lin Chun-Liang, Lee Bih-O. Relationships of illness representation and quality of life in patients with end‐stage renal disease receiving haemodialysis. J Clin Nurs. 2020;29:3812-21. doi:10.1111/jocn.15412.

Hwang Y, Kim M, Min K. Factors associated with healthrelated quality of life in kidney transplant recipients in Korea. PLoS One. 2021;16(3):e0247934. https://doi.org/10.1371/journal.pone.0247934

Tiansawad S. editor. Instrument development for nursing research. 1st ed. Chiang Mai: Siampimnana; 2019 (in Thai).

Moss-Morris R, Weinman J, Petrie KJ, Horne R, Cameron LD, Buick D. The revised Illness Perception Questionnaire (IPQ-R). Psychol and Health. 2002;17(1):1-16. doi:10. 1080/08870440290001494.

Tucker EL, Smith AR, Daskin MS, Schapiro H, Cottrell SM, Gendron ES, et al. Life and expectations post-kidney transplant: a qualitative analysis of patient responses. BMC Nephrol. 2019;20:175. https://doi.org/10.1186/s12882-019-1368-0

Megawati, Yetti K, Sukmarini L. The factors affecting the quality of life of kidney transplantation patients at the Cipto Mangunkusumo General Hospital in Jakarta, Indonesia. Enferm Clin. 2019;29(S2):428-33. https://doi.org/10.1016/j.enfcli.2019.04.063

Koya SNMVM, Zulkepli NA. Associations between phosphate binders prescription, illness perception, and depression in hemodialysis patients. Saudi J Kidney Dis Transpl. 2018;29(4):828-36.

Gela D, Mengistu D. Self-management and associated factors among patients with end-stage renal disease undergoing hemodialysis at health facilities in Addis Ababa, Ethiopia. Int J Nephrol Renovasc Dis. 2018;11:329-36.

Azar FEF, Solhi M, Soola AH, Amani F. Quality of life and its related factors in kidney transplant recipients. Amazonia Investiga. 2019;8(21):449-59.

Most read articles by the same author(s)

1 2 3 > >>