EXPERIMENTAL AND CLINICAL TRANSPLANTATION

Kidney transplant extends the life span of recipients and increases the quality of life by offering both emotional and psychological benefits to the recipient.^1,2 However, the transplanted kidney can also be considered as a “foreign body,” may cause internal psychological conflicts about the new organ, and may result in the graft not being psychologically accepted.^3,4 Psychological problems experienced by kidney transplant recipients can lead to decreased quality of life and physical health, organ rejection, and mortality.^5,6 Physiological and psychological problems that develop in kidney transplant recipients can disrupt the recipient’s harmony and affect the healing process.¹ A qualitative study indicated that many recipients experience fear of infection and, consequently, anxiety.⁷ In a literature review investigating the life experiences of living donor kidney transplant recipients, recipients were reported to commonly experience strong fears of the unknown and feelings of being indebted to the donor.⁸ Lai and colleagues (2020) reported that 13.6% of kidney transplant recipients experienced severe depression and 6.6% exhibited symptoms of stress.⁹ Living donor kidney recipients have been reported to experience a stronger sense of guilt than deceased donor recipients.^10,11 Lai and colleagues (2020) reported the prevalence of transplant-specific guilt among living and deceased donor kidney transplant recipients of 37.7% and 9.3%, respectively.⁹ Certain personal and clinical characteristics of kidney transplant recipients can influence their levels of depression, anxiety, and stress after transplant.¹²

In this review, we aimed to provide an up-to-date literature search on recommendations addressing the psychological problems experienced by kidney transplant recipients after transplant.

Materials and Methods

We identified studies by searching the PubMed, ScienceDirect, and Web of Science databases for the past 5 years. The search terms used included “depression, anxiety,” “kidney transplant recipients,” “kidney transplantation,” “psychosocial problems,” and “psychosocial issues.” The OR operator was used for similar types and concepts, whereas the AND operator was used for different types and concepts. We conducted the search on July 10, 2023. This literature review was structured by using (and visualized) the PRISMA flow diagram (Figure 1).

Only studies that were accessible in full text, written in English, and conducted on adult kidney transplant recipients were included. Protocol studies, systematic reviews, and meta-analyses were not included in this literature review.

Our searches of the relevant databases resulted in 1663 articles transferred to EndNote: 243 from PubMed, 1198 from ScienceDirect, and 222 from Web of Science. On examination of these articles, we excluded 9 studies (1 article because it was a review article, 2 articles because they were protocol studies, 2 articles because they included kidney transplant recipients under the age of 18, and 4 articles because they did not fit the purpose of this review). In total, we included 21 articles in this review. Among included articles, we obtained information on the year of publication, country, study type, measurement tools used, number of kidney transplant recipients included in the study, and significant findings. (Table 1) summarizes the included studies.

Approximately half of the included articles (n = 9, 42.9%) were cross-sectional studies. The sample sizes of the included articles ranged from a minimum of 36 (cross-sectional study) to a maximum of 5234 (long-term population study) kidney transplant recipients.

Discussion and Conclusions

Kidney transplant recipients may be exposed to many physical and psychological stresses, along with the need to cope with new anxieties to cope, such as following a complex medical regimen and fear of rejection in the posttransplant period. This process can cause various psychological disorders such as depression. Uncertainty about the future after transplant, fear of the unknown, physiological and psychological side effects of long-term drug therapy, changes in social life, depression, and stress may cause anxiety in recipients.

Basiri and colleagues (2020) suggested strategies and regular training to provide support for kidney transplant recipients in resolving psychological issues.¹³Another study also recommended conducting further research to identify, manage, control, and prevent psychological risk factors and to enhance interventions for better outcomes.² Rocha and colleagues (2020) emphasized on the importance of an orientation program to be provided to kidney transplant recipients through healthcare professionals, particularly nurses. In addition, maintaining communication between a multidisciplinary team, the recipient, and their family was recommended¹⁴to assess depression. ¹⁵Recipients with depressive symptoms should receive individual interventions tailored to their specific circumstances.¹⁵

In light of findings that kidney transplant recipients experience depression, anxiety, and stress during the posttransplant period, it is recommended to support kidney transplant recipients posttransplant and implement interventions aimed at reducing their depression, anxiety, and stress levels.

Volume: 22 Issue: 1 January 2024 - Supplement - 1

FULL TEXT