Research demonstrates that psychological factors are important for positive transplant outcomes, though there is little literature that synthesizes these factors in a comprehensive model among pediatric kidney transplant patients. This review analyzes psychological and psychosocial factors related to medical outcomes and overall well‐being post‐transplant by utilizing the PPPHM and referencing the existing literature on risk and resilience. Pediatric kidney transplant recipients are more susceptible to mental health concerns such as depression, anxiety, and ADHD, as well as developmental and neurocognitive delays, compared to healthy peers. Complex medical care and psychosocial needs for patients have implications for family functioning, parental and sibling mental health, and youth readiness to transition to adult care. It is important to carefully monitor patient functioning with empirically validated tools and to intervene in a multidisciplinary setting as early as possible to identify patients at risk and reduce potential negative impact. Psychologists are uniquely trained to assess and address these issues and are a valuable component of multidisciplinary, culturally competent care. While research in this expansive field is improving, more data are needed to establish gold standard approaches to mental health and psychosocial care in this population.

Background: Equitable access to pediatric organ transplantation is critical, although risk factors negatively impacting pre-and post-transplant outcomes remain. No synthesis of the literature on SDoH within the pediatric organ transplant population has been conducted; thus, the current systematic review summarizes findings to date assessing SDoH in the evaluation, listing, and post-transplant periods. Methods: Literature searches were conducted in Web of Science, Embase, PubMed, and Cumulative Index to Nursing and Allied Health Literature databases. Results: Ninety-three studies were included based on pre-established criteria and were reviewed for main findings and study quality. Findings consistently demonstrated disparities in key transplant outcomes based on racial or ethnic identity, including timing and likelihood of transplant, and rates of rejection, graft failure, and mortality. Although less frequently assessed, variations in outcomes based on geography were also noted, while findings related to insurance or SES were inconsistent. Conclusion: This review underscores the persistence of SDoH and disparity in equitable transplant outcomes and discusses the importance of individual and systems-level change to reduce such disparities. K E Y W O R D S social determinants of health, disparity, pediatric organ transplantation 2 of 33 | REA et al. 1 | INTRODUC TI ON Equitable access to organ transplantation and subsequent transplantrelated medical care is a critical goal across healthcare centers. Over the years, studies have identified risk factors impacting listing status and transplant-related outcomes, with greater scrutiny recently on clinical tools impacting organ allocation, selection, and donation processes. 1 These steps are critical in identifying areas of structural racism which continue to impact Black, Indigenous, and people of color as well as the intersectionality of socioeconomic factors within the patient population as a whole. To summarize findings to date, a systematic review of the available literature was conducted. Studies included assessments of SDoH in the evaluation, listing, and post-transplant periods. The US Department of Health and Human Services identifies five domains of SDoH that include economic stability, education access and quality, healthcare access and quality, neighborhood and built environment, and social and community context. 2 Special consideration was given to dynamic interplay between these factors to better understand social processes underlying health outcomes and identify potential intervention areas. | ME THODS | Search strategyThis systematic review is in accordance with PRISMA guidelines.Comprehensive search strategies were created for Web of Science, Embase, PubMed, and Cumulative Index to Nursing and Allied Health Literature, including controlled vocabulary terms from each database combined logically with keywords using Boolean Logic. Terms were extracted per the following concepts: pediatrics, organ transplantation, disparities, and identity (see example searc...

Background Delayed time to listing (TTL) for pediatric transplant patients is associated with increased risks of mortality and morbidity. The full range of health disparities, sociodemographic factors, and other barriers associated with delays in listing in the pediatric transplant candidate evaluation process has not been fully examined. Methods Retrospective chart reviews were conducted for 183 kidney, liver, and heart transplant candidates ages 0–18 who were referred for evaluation during 2012–2015. Demographic information and potential barriers (e g., social/medical factors, financial concerns) were gathered from pre‐transplant evaluations and included in a comprehensive model to evaluate mechanisms that explain differences in TTL. Descriptive statistics, logistic regression models, Cox proportional hazards models, and path analysis were used for analyses. Results Candidates included 26.8% heart, 33.3% liver, and 39.9% kidney patients. The most common barrier to listing was financial (71.6%), followed by caregiver psychological or substance use (57.9%), and medical problems (49.7%). Higher age, kidney, and liver organ type (relative to the heart), and presence of social, medical, administrative/motivation, and financial barriers were all directly associated with longer TTL. Public insurance was indirectly associated with TTL through social, administrative/motivation, and financial barriers. Organ type was indirectly associated with TTL through financial barriers. Conclusions Results suggest social problems, administrative issues, and financial issues act as mechanisms through which insurance type and liver transplant candidates face increased risk of delays in transplant listing time. There are numerous clinical implications and interventions that are warranted to reduce TTL among pediatric transplant candidates with co‐occurring barriers.

Rates of the demand for transplantation continue to rise and exceed the supply of available organs. 1 To maximize the successful transplantation of a limited number of available organs, research has highlighted the importance of identifying and treating psychosocial factors, including substance use, present at the pre-transplant evaluation, due to their association with poor post-transplant outcomes (ie, nonadherence, increased risk for rejection, and graft failure). [2][3][4] Studies have examined risk by organ type, but the existing literature largely focuses on marijuana and alcohol use within predominantly adult transplant populations. 5 Though less data exist on substance use rates in pediatric transplant patients, youth substance use in the general population remains a public health concern. 6 Several large longitudinal studies highlight increases in marijuana use as adolescent age increases,