Cosmetic side effects of immunosuppressive therapy in children and adolescents with renal grafts

Holistic care and symptom management for pediatric kidney transplant recipients

While many aspects of life may improve substantially for children and young people undergoing kidney transplant, there may be new challenges including symptoms that can be detrimental to health-related quality of life. Addressing symptoms requires attention to patient and family perspectives and a holistic approach grounded in symptom management. The interdisciplinary pediatric nephrology transplant team should be attuned to the prevalence of common symptoms including fatigue, anxiety, depression, post-traumatic stress, pain, and sleep disturbances, as well as poor body image and sexual health. These common symptoms require regular assessment with a focus on appropriate interventions and how care may be impacted by transplant status.

Body Image in Liver Transplantation Recipients

Body image (BI) concerns have been reported to play a significant role in the psychological adaptation after organ transplantation. There is a paucity of data about BI beliefs in liver transplant recipients. We report the results of a cross-sectional study of 177 liver transplant recipients for whom we assessed BI, anxiety, depression, and quality of life (QOL) using validated instruments. Our results indicate that higher BI concerns correlated with higher levels of anxiety and depression. BI concerns were more elevated in females, younger patients, and patients with a lower income. Patients with chronic liver disease had more BI concerns than patients who received liver transplantation for acute liver failure. Specific BI concerns also correlated independently with QOL scores. We conclude that BI concerns are significant in liver transplant recipients and should be evaluated by clinicians involved in the mental health care of this population.

Body image in transplant recipients and living organ donors

PURPOSE OF REVIEW

The purpose of this article is to describe the current evidence regarding the prevalence and significance of concerns about body image in transplant recipients and organ donors.

RECENT FINDINGS

Body image and organ integration concerns have been reported as main themes in the psychological adaptation to transplantation. Their prevalence, severity, description and impact vary wildly. There is a lack of validated instruments to measure body image or organ integration in transplant patients. For organ recipients, satisfaction with body image depends on the organ, genre, pretransplant medical illness, time since transplantation and post-transplant medication regimen. Complete or partial denial of the graft is frequently reported. For organ donors, body image is influenced by the type of surgical incision. There is little evidence that body image or organ integration impact medical or psychological outcomes after transplantation or organ donation.

SUMMARY

Body image is becoming a significant component of measuring the quality of life in transplant patients. Body image may become a factor in decisions about if and when to pursue transplant for nonlife-threatening conditions (e.g. face transplantation), about the type of incision or about the immunosuppressant regimen. For mental health professionals, understanding the complexities of body image and organ integration will help enhance the assistance provided before and after transplant or donation.

Psychological profile of adolescents with a kidney transplant

To describe the psychological profile of renal transplant adolescents compared to healthy peers and to adolescents with CKD, three groups of adolescents aged 12-18 yr were selected: TX, CX, and adolescents with CKD. Psychiatric symptoms and disorders were evaluated through direct interviews (K-SADS-PL) and self-report questionnaires (YSR and CBCL). Forty TX (14 LRD and 26 DD transplant recipients), 40 CX and 20 CKD were included. Twelve of 40 (30%) TX, three of 20 (15%) CKD, and three of 40 (7.5%) CX had a history of learning difficulties (p = 0.03). Compared to CX, TX had lower total YSR competencies score (p = 0.028) and lower total CBCL competencies score (p = 0.003). Twenty-six of 40 (65%) TX, 12 of 20 (60%) CKD and 15 of 40 (37.5%) CX (p = 0.038) met DSM-IV diagnostic criteria for lifetime psychiatric disorder, with rates of depressive disorder of 35% among TX and CKD compared to 15.2% among CX (p = 0.043). Eight of 40 (20%) TX had a history of simple phobia. Nine of 40 (22.5%) TX met diagnostic criteria for ADHD as compared to one of 20 (5%) CKD and three of 40 (7.5%) CX. In the TX group, we found no significant differences in educational and psychiatric variables between LRD and DD. In conclusion, we found a high prevalence of psychiatric morbidity (depression, phobia, ADHD), educational impairment and social competence problems in the TX group. CKD scored in between TX and CX on most measures.