SRS296 - Factors affecting decision regret following renal transplantation

Abstract Renal transplantation is the optimal form of renal replacement therapy (RRT). However, for patients with a narrow risk-benefit ratio, the decision to transplant is difficult, with potential for regret. Decision regret is associated with poor quality of life (QoL) and risks damage to the clinician-patient relationship. Decision regret has not previously been studied in renal transplant recipients. This study aims to quantify decision regret, identify risk factors and examine its relationship with QoL. The decision regret scale (DRS) was used to quantify regret one-year post-transplant. Baseline demographics, transplant-specific factors and postoperative outcomes were analysed to screen for risk factors. Patient DRS scores were compared with clinician regret scores. Finally, DRS scores were compared to EQ-5D-5L scores. 201 patients responded, 28.3% of whom reported decision regret (95%c.i. 22.6--34.9). Three significant risk factors were identified: a longer duration of prior RRT (OR = 1.05, 95%c.i. 1.0--1.1, P = 0.04), an ‘unknown’ primary renal disease diagnosis (OR = 3.9, 95%c.i. 1.4--11.4, P = 0.01) and biopsy-proven acute rejection (OR = 3.4 95%c.i. 1.1--11.4, P = 0.04). A higher 3-month eGFR was found to be protective against decision regret (OR = 0.96, 95%c.i. 0.9–1.0, P = 0.01). DRS score and QoL were linearly associated (P < 0.001). There was poor agreement between clinicians and patients (kappa statistic:0.17–0.31). A high prevalence of decision regret was expressed following renal transplantation, with identified risk factors offering limited scope for clinical modification. A clear association exists between QoL and decision regret. Discordance was evident between clinician and patient decision regret. Regret analysis offers a tool for evaluation of the provision of realistic medicine.