Psychosocial Risk Factors in Pediatric Renal Transplant Patients
Sarah Ashley, BS1, Arun Chandnani, MD1, Zachary Arcona, PsyD1, Elizabeth S. Christofferson, PhD1, Kara Monnin, PhD2, Carter Sevick, MS1, Vijaya Vemulakonda, MD1, Jonathan Walker, MD3, Margret Bock, MD1, Cindy Buchanan, PhD1.
1University of Colorado School of Medicine, Aurora, CO, USA, 2Nationwide Children's Hospital, Columbus, OH, USA, 3University of Tennessee Chattanooga College of Medicine, Chattanooga, TN, USA.
BACKGROUND: Psychosocial risk and resilience factors associated with graft outcomes are assessed in pre-transplant evaluations. The Pediatric Transplant Rating Instrument (P-TRI) is a validated 17-item rating scale administered by psychologists during pre-transplant evaluations for pediatric transplant candidates. The instrument identifies overall risk, illness related factors, treatment adherence, psychiatric history, substance use history, family environment, and logistical barriers that may impact transplant success. This study evaluates the relationship between medical diagnostic factors and patient psychosocial risk factors as measured by the P-TRI.
Methods: A retrospective chart review of 177 pediatric kidney transplant candidates evaluated at Children’s Hospital Colorado between 2013 and 2021 was performed. Candidates were grouped into one of three diagnostic categories: congenital abnormalities of the kidneys and urinary tract (CAKUT), primary renal, or syndromic neurogenic bladder. Data collected included demographics, P-TRI results, and dialysis and catheterization status at the time of evaluation. Differences in adherence and total risk were analyzed using cumulative logistic regression, with higher P-TRI totals and adherence sub-scale scores indicating less risk. Analyses were conducted using SAS v.9.4 (Cary, NC).
Results: Patients who catheterized at the time of evaluation had lower adherence scores than patients who did not catheterize (OR 0.46, p=0.023). Patients with primary renal and syndromic neurogenic bladder diagnoses trended towards lower adherence scores compared to CAKUT patients (OR 0.72, 0.35 respectively, p=0.09). Patients on dialysis trended towards higher adherence scores compared to those not on dialysis (OR 1.66, p=0.075). Of the patients on dialysis, CAKUT patients had higher adherence scores than primary renal patients (OR 1.84, p=0.095), although these results were not significant when controlling for age (OR 1.31, p=0.49). Each additional year of life was weakly associated with lower P-TRI scores (OR 0.96, p=0.068). Hispanic patients trended towards lower P-TRI scores compared non-Hispanic patients (OR 0.72, p=0.093). Primary renal patients were more likely to be at risk for psychiatric concerns compared to CAKUT patients (OR 2.029, CI=1.081, 3.809). Patients with a primary language other than English were more likely to score in the at-risk category for knowledge about transplant in the illness factors variable of the P-TRI (p=0.052).
CONCLUSIONS:
Treatment adherence has significant impacts on graft outcome; therefore early interventions for psychosocial risk factors are essential. This study found that catheterization status, dialysis status, age, and initial diagnosis may impact patient adherence and offer opportunities for early intervention. Within the P-TRI categories, patients with primary renal versus CAKUT diagnoses were more likely to be at risk for psychiatric concerns that may require treatment to support a successful transplant; this suggests a need for additional psychiatric support in patients with primary renal disease. Finally, language may pose an obstacle for patients in gaining comprehensive understanding of transplant issues. Further studies are needed to understand underlying psychosocial risk and resilience factors and investigate correlations between identified risk factors and long term graft outcomes.
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