Psychological functioning and psychosocial issues in pediatric kidney transplant recipients

Abstract

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.

Caregiver‐reported outcomes of pediatric transplantation: Changes and predictors at 6 months post‐transplant

“…These caregivers would likely benefit not only from education from medical providers who can provide additional information about the expected medical course during the transplantation process but also support from psychosocial staff (e.g., social workers, psychologists) who can incorporate more check‐ins regarding caregiver mental health functioning during regular post‐transplant clinic visits. Caregivers whose children had psychosocial difficulties prior to transplant may experience emotional fatigue from caring for themselves and their child, supporting prior literature demonstrating pediatric psychosocial needs are likely to impact parent functioning 17 and suggesting that assessment of child psychosocial needs prior to transplant could identify families who may benefit from additional psychosocial support services. These services may include brief interventions during outpatient clinic encounters, referrals for longer‐term therapy outside of patients’ regularly scheduled transplant center visits, or connecting interested caregivers with ambassador families or social media groups for peer support.…”

African Americans’ discussions about living‐donor kidney transplants with family or friends: Who, what, and why not?

“…18,30,36,37 Much nephrology research on family functioning has focused on pediatric patients at various stages of the transplant process to enhance understanding of the disease course, psychological functioning, and health-related outcomes. [38][39][40] Our finding serves as a reminder that the family remains an influential interpersonal context in adulthood. From a clinical care standpoint, our finding suggests efforts are needed to comprehend the characteristics and contexts of the transplant candidate's social network.…”

“…Measurement of family functioning provides insight into the functional state or health of the family as a relational social system, including how the family typically behaves, interacts, and responds when confronted with stressful experiences such as chronic disease 18,30,36,37 . Much nephrology research on family functioning has focused on pediatric patients at various stages of the transplant process to enhance understanding of the disease course, psychological functioning, and health‐related outcomes 38–40 . Our finding serves as a reminder that the family remains an influential interpersonal context in adulthood.…”

Providers and Families Weigh in on Delays to Pediatric Kidney Transplant Wait-List Activation

“…Although pediatric patients who are listed for a transplant on the deceased donor waiting list often get transplants within a year, 3 there is variability in who becomes listed. Compared to others, pediatric patients who do not have private insurance, 4 have parents with less than a college education level, 4 have a history of depression or anxiety, 5 or have intellectual disabilities 6 are less likely to be wait-listed. Also, Black and Hispanic children have a lower likelihood of getting on the transplant list, after controlling for economic disparities, 5,7,8 and they are 12% to 39% less likely to receive a transplant within a year of starting dialysis.…”