Psychosocial Risk Factors for Transplantation in Pediatric Patients with Urologic Conditions
Cindy L. Buchanan, PhD, Elizabeth Steinberg, PhD, Carter Sevick, MS, Jonathan Walker, MD, Vijaya Vemulakonda, MD.
University of Colorado School of Medicine, Aurora, CO, USA.
Background: Screening for psychosocial risk factors is a required component of pre-transplant evaluations. It is unknown how children with primary urologic disease compare to children with primary renal disease on psychosocial risk factors. The goal of the current study is to compare pre-transplant psychosocial risk factors in pediatric kidney transplant candidates with primary urologic disease to those candidates with primary renal disease. It was hypothesized that pediatric patients with primary urologic disease would have more overall psychosocial risk factors and, specifically, more adherence risk factors due to the complexity of their care and chronicity of their disease state. Methods: A retrospective review of ratings on the Pediatric Transplant Rating Inventory (P-TRI) completed during pre-transplant evaluations between September 2013 and May 2017 was conducted. The P-TRI total scale, the adherence subscale, and individual items were analyzed for differences between primary urologic and renal patients, with higher scores on the P-TRI indicating less psychosocial risk. Items were dichotomized to 4 and less than 4 with differences assessed by Pearson’s chi-square test, Fisher’s exact test, and Wilcoxon rank sum test. Results: 82 pediatric kidney transplant candidates were included. Candidates were classified as having either primary renal disease (n = 59, 71.95%) or primary urologic disease (n = 23, 28.05%). Candidates had a mean age of 12.58 years (range 0.5-19 years, SD = 4.65), were primarily white (67.07%), female (53.66%), non-Hispanic (67.07%), and had public insurance (70.7%). Most families were English speaking (86.59%). There were no statistically significant differences between children with primary renal disease children and children with primary urologic conditions on the overall P-TRI score (p = 0.21) or the adherence subscale (p = 0.09). On analysis of individual items, children with primary urologic disease were more likely to have risk factors related to adherence than children with primary renal disease, although this did not reach statistical significance (p = 0.07). When analyzing knowledge about transplant, urologic patients had less understanding and knowledge about the transplant process than those with primary renal disease (p = 0.02). Conclusions: The overall risk for patients with primary renal and primary urologic conditions undergoing pre-transplant evaluations is similar. However, children with urologic disease and their families have less comprehensive understanding about the transplant process and there is some evidence that they have more risk factors for non-adherence than their renal disease counterparts. These findings support the need for earlier interventions for urology patients to address these factors prior to transplant. Further studies are needed to understand the etiology of these differences and the potential benefit of more comprehensive psychosocial supports for children with urologic conditions at-risk for future renal transplantation.
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