Symptom Experience Associated With Immunosuppressive Medications in Chinese Kidney Transplant Recipients

Kidney transplantation (KT) has gradually become a standard procedure for end-stage kidney disease, which aims to improve the survival rate of patients and their quality of life. Kidney transplant recipients require lifelong treatment with immunosuppressive medications. Nevertheless, choosing the best suitable immunosuppressive therapy regimen is still fairly complex. Multiple classes of medications have been simultaneously used. Usually, the immunosuppressive regimens include calcineurin inhibitors such as cyclosporine or tacrolimus; steroids; and antimetabolites such as azathioprine or mycophenolate mofetil or proliferation signal inhibitors such as sirolimus and everolimus worldwide (Almeida et al., 2013), as well as in China. Moreover, an increasing range of adverse events must be considered when deciding on the optimal immunosuppressive strategy for an individual patient; thus, the balance of advantages and disadvantages is used to determine the regimen of choice. Healthcare providers tend to focus mainly on the side effects directly related to morbidity and mortality, such as high blood pressure, nephrotoxicity, and cancer (Dandel, Lehmkuhl, Knosalla, & Hetzer, 2010; Kugler et al., 2009). Recipients' perceived symptoms associated with side effects are highly subjective and include excess hair growth, tiredness, and trembling hands, and although disturbing, little attention is given to them. These symptom experiences may directly or indirectly influence other important outcomes, as several studies have demonstrated that a high level of symptom experience may lead to a reduced quality of life, medication nonadherence, and subsequently a decreased graft survival (Cheng, Lin, Chang, Shu, & Wu, 2012; Denhaerynck et al., 2007; Kugler et al., 2009; Moons et al., 2003; Rosenberger et al., 2005). Thus, the better understanding of symptom experience associated with immunosuppressive medications is significant for healthcare providers to develop interventions to improve recipients' quality of life and reduce medication nonadherence.Symptom experience is defined as a recipient's subjective experience of side effects associated with immunosuppressive medications, which consists of two aspects: symptom occurrence and symptom distress (Leventhal, Diefenbach, & Leventhal, 1992). Symptom occurrence is a cognitive pathway of symptom experience to perceive the frequency of symptoms (Leventhal et al., 1992). Symptom distress is an emotional pathway to perceive how life is influenced by symptoms (Leventhal et al., 1992). The most frequent symptom may not be the most distressing symptom (Moons et al., 2003); thus, distinguishing the two aspects is necessary for healthcare providers. Symptom distress is influenced by personal and social environmental factors, such as emotional status, previous illness experiences, and demographic factors (Kugler et al., 2009). The literature has consistently shown that women tend to experience a higher level of symptom distress than men, and that symptoms experienced by women differ from those of men (Koller et al., 2010; Kugler et al., 2009; Moons et al., 2003; Rosenberger et al., 2005; Wang et al., 2013). A gender-specific evaluation of symptom experience is thus in need. The immunosuppressant regimen of recipients between short-term and long-term post-transplantation are different. The period of time after transplantation is another important factor of symptom experience (Kugler et al., 2007; Matas et al., 2002; Rosenberger et al., 2005). However, a few studies have evaluated the symptom experience associated with immunosuppressive medications after KT, especially in comparison of symptom experience based on the duration of follow-up after transplantation. As the immunosuppressive medications have been optimized, a new evaluation of symptom experience related to immunosuppressive medications is required.Medication adherence is an important issue for organ transplant recipients, and nonadherence to immunosuppressive medication is one of the causes of acute rejection and graft loss (Denhaerynck et al. …