Health-related quality of life changes following renal transplantation in children

The Determinants of Psychological Well-Being Among Kidney Transplant Recipients in Kazakhstan: A Cross-Sectional Study

Background: Kidney transplantation (KTx) significantly improves survival and quality of life in patients with end-stage renal disease. However, post-transplant well-being is influenced by multiple factors, including healthcare accessibility, satisfaction with medical care, and psychological health. This study aimed to assess the well-being of post-KTx patients in Kazakhstan and examine its associations with healthcare access, satisfaction, and anxiety. Methods: A cross-sectional study was conducted among 223 post-KTx patients in Kazakhstan. Participants were recruited through online surveys and telephone interviews. Only patients who had undergone transplantation within Kazakhstan were included. The WHO-5 Well-Being Index was used to measure well-being, and additional surveys assessed healthcare access, satisfaction with post-KTx care, and treatment-related anxiety. Multiple linear regression was performed to identify predictors of well-being. Results: The mean WHO-5 well-being score was 66.1 (SD = 24.6), indicating moderate well-being. Satisfaction with post-transplant information (β = 0.287, p = 0.015) and educational level (β = 0.172, p = 0.019) were significant positive predictors of well-being. In contrast, post-KTx anxiety (β = -0.154, p = 0.024) and difficulties in accessing medical care (β = -0.216, p = 0.014) negatively affected well-being. Patients residing in rural areas reported greater barriers to post-transplant care compared to those in urban settings (χ2 = 31.6, p = 0.002). Conclusions: Post-KTx well-being in Kazakhstan is influenced by educational level, access to healthcare, satisfaction with medical information, and anxiety levels. Targeted interventions to improve access to post-transplant care, enhance patient education, and address psychological distress may help improve outcomes for post-KTx patients.

Life experiences after kidney transplantation in adolescents: A qualitative meta-synthesis

PURPOSE

To systematically evaluate the life experience of adolescents after kidney transplantation.

METHODS

We use computer search Web of Science, PubMed, Cochrane Library, Embase, EBSCO, CNKI, Wanfang, VIP database, search database to October 2024, screening after kidney transplant adolescents life experience of qualitative study. We used the Australian Joanna Briggs Institute Critical Appraisal Checklist for Qualitative Research to quality evaluation, and using the thematic analysis method to integrate the results.

RESULTS

7 articles were included, and 31 research results were integrated into 8 new categories and combined results are 3 integration results: complex emotional experience; eager for multifaceted support; self-adjustment.

CONCLUSION

Nursing staff should pay attention to the psychological experience and needs of adolescents, to eliminate their stigma, to promote positive cognition, and to improve their quality of life.

Quality of Life in Pediatric CKD Patients on Dialysis vs Renal Transplantation: A Comparative Study of the Perspectives of Parents and Children

BACKGROUND

Chronic kidney disease (CKD) is a burden on children and their caregivers, especially in advanced stages requiring different renal replacement modalities (peritoneal/hemodialysis and renal transplant). The aim of the study is to measure the health-related quality of life (HRQOL) of children and their caregivers for each renal replacement modality, specifically dialysis and transplant.

METHODS

This study is a single-center cross-sectional study that was carried out at King Fahad Specialist Hospital in Dammam (KFSH-D). A total of 57 participants ranging from 5 to 18 years of age were included in the study, comprised of 42 patients and their parents in the transplant arm and 15 patients and their parents in the end-stage renal disease (ESRD) arm. The HRQOL was measured using the Pediatric Quality of Life Inventory (PedsQL) version 3.0 ESRD and transplant modules, respectively.

RESULTS

The mean scores for HRQOL for children receiving dialysis were found to be 60.2 ± 22.6, which was significantly lower than the scores for children who had undergone transplantation (84.1 ± 14.7, P = .001). Additionally, the scores for the parents providing proxy reports for children on dialysis (52.5 ± 25.7) were also significantly lower compared with those for parents of children who had undergone transplantation (83.8 ± 13.9, P ≤ .001).

CONCLUSIONS

This research demonstrated that HRQOL of both children who had undergone transplants and their caregivers was notably superior to that of individuals with ESRD. Which reinforces the importance of timely kidney transplantation in children and its positive impact on both physical and psychosocial well-being.

Family Environment, Social Support, and Health-Related Quality of Life in Adolescents Following Kidney Transplant

BACKGROUND

Kidney transplantation is the treatment of choice for pediatric end-stage renal disease. Transplant recipients often have better neurocognitive, academic, and health-related outcomes. While there is some evidence that health-related quality of life (HRQOL) improves following kidney transplant, other studies have found adolescent transplant recipients report lower overall HRQOL than healthy peers. Current research has focused on individual-level factors affecting adjustment to organ transplant, warranting examination of HRQOL from a systems perspective. Family environment and social support contribute to a system of proximal relationships that are crucial in adolescents' development, making them important factors to study in relation to HRQOL post-transplant.

METHODS

The current study utilized archival data of adolescent renal transplant patients who completed surveys about their family environment, social support, and HRQOL during routine transplant clinic visits.

RESULTS

Family cohesion, as well as social support from parents, classmates, and people in school, were positively correlated with HRQOL. Social support from people in school uniquely predicted variance in HRQOL, beyond the contribution of overall family environment after controlling for demographic factors. Relative to comparable adolescent samples, transplant recipients reported more optimal overall family environment, greater social support from teachers, and lower social support from close friends.

CONCLUSION

Psychosocial interventions for adolescent kidney transplant recipients may be enhanced by collaborating with school professionals and further bolstering strengths in the family environment. Kidney transplant recipients may benefit from long-term intervention, as decreased HRQOL appears to persist years post-transplant.

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.

Protocol for a multicentre prospective exploratory mixed-methods study investigating the modifiable psychosocial variables influencing access to and outcomes after kidney transplantation in children and young people in the UK

INTRODUCTION

Kidney transplantation is the preferred therapy for children with stage 5 chronic kidney disease (CKD-5). However, there is a wide variation in access to kidney transplantation across the UK for children. This study aims to explore the psychosocial factors that influence access to and outcomes after kidney transplantation in children in the UK using a mixed-methods prospective longitudinal design.

METHODS

Qualitative data will be collected through semistructured interviews with children affected by CKD-5, their carers and paediatric renal multidisciplinary team. Recruitment for interviews will continue till data saturation. These interviews will inform the choice of existing validated questionnaires, which will be distributed to a larger national cohort of children with pretransplant CKD-5 (n=180) and their carers. Follow-up questionnaires will be sent at protocolised time points regardless of whether they receive a kidney transplant or not. Coexisting health data from hospital, UK renal registry and National Health Service Blood and Transplant registry records will be mapped to each questionnaire time point. An integrative analysis of the mixed qualitative and quantitative data will define psychosocial aspects of care for potential intervention to improve transplant access.

ANALYSIS

Qualitative data will be analysed using thematic analysis. Quantitative data will be analysed using appropriate statistical methods to understand how these factors influence access to transplantation, as well as the distribution of psychosocial factors pretransplantation and post-transplantation.

ETHICS AND DISSEMINATION

This study protocol has been reviewed by the National Institute for Health Research Academy and approved by the Wales Research Ethics Committee 4 (IRAS number 270493/ref: 20/WA/0285) and the Scotland A Research Ethics Committee (ref: 21/SS/0038). Results from this study will be disseminated across media platforms accessed by affected families, presented at conferences and published in peer-reviewed journals.

Health-related quality of life for pediatric patients with end-stage kidney disease: A systematic review and meta-analysis of the Pediatric Quality of Life Inventory (PedsQL)

INTRODUCTION

Health-related quality of life (HRQoL) studies demonstrate the impact of end-stage renal disease (ESRD) on the physical and psychosocial development of children. While several instruments are used to measure HRQoL, few have standardized domains specific to pediatric ESRD. This review examines current evidence on self and proxy-reported HRQoL among pediatric patients with ESRD, based on the Pediatric Quality of Life Inventory (PedsQL) questionnaires.

METHODS

Following PRISMA guidelines, we conducted a systematic review and meta-analysis on HRQoL using the PedsQL 4.0 Generic Core Scale (GCS) and the PedsQL 3.0 ESRD Module among 5- to 18-year-old patients. We queried PubMed, Embase, Web of Science, CINAHL, and Cochrane databases. Retrospective, case-controlled, and cross-sectional studies using PedsQL were included.

FINDINGS

Of 435 identified studies, 14 met inclusion criteria administered in several countries. Meta-analysis demonstrated a significantly higher total HRQoL for healthy patients over those with ESRD (SMD:1.44 [95% CI: 0.78-2.09]) across all dimensional scores. In addition, kidney transplant patients reported a significantly higher HRQoL than those on dialysis (PedsQL GCS, SMD: 0.33 [95% CI: 0.14-0.53]) and (PedsQL ESRD, SMD: 0.65 [95% CI: 0.39-0.90]) concordant with parent-proxy reports.

DISCUSSION

Patients with ESRD reported lower HRQoL in physical and psychosocial domains compared with healthy controls, while transplant and peritoneal dialysis patients reported better HRQoL than those on hemodialysis. This analysis demonstrates the need to identify dimensions of impaired functioning and produce congruent clinical interventions. Further research on the impact of individual comorbidities in HRQoL is necessary for developing comprehensive, integrated, and holistic treatment programs.

Time from kidney failure onset to transplantation and its impact on growth in pediatric patients

BACKGROUND

In children with kidney failure, the longer the duration of dialysis the greater the impact on growth deficit, quality of life, and life expectancy. The aim of this research is to test whether there was a shortening of treatment time from kidney failure to transplantation in pediatric patients and whether this time interval impacted height.

METHODS

Observational retrospective cohort study from 2005 to 2018. The first outcome variable was time to transplantation in years, while the second was height/age standard deviation score (SDS) at transplantation. Cox regression models were used to analyze time from disease to transplantation and linear regression was employed to test the association of the year of kidney failure onset with height.

RESULTS

A total of 780 children were evaluated and 517 underwent kidney transplantation after a median time of 1.9 years (IQR = 1.0-4.0). The variables significantly associated with time to transplant were: year of kidney failure onset (HR = 1.07; 95% CI: 1.05-1.10; p < .001), age at kidney failure onset <12 years (HR = 0.59; 95% CI: 0.49-0.71; p < .001), living in different state as transplant center (HR = 0.63; 95% CI: 0.53-0.77; p < .001), and undergoing blood transfusion before transplantation (HR = 0.63; 95% CI: 0.53-0.75; p < .001). Regarding growth, for each 1-year increase in the epoch of kidney failure onset, a 0.05 SDS raise in height/age is expected (p < .001).

CONCLUSION

Children with recent kidney failure onset had significantly lower time to the outcome and this reduction was associated with a less severe growth deficit.

Pediatric kidney transplants with multiple renal arteries show no increased risk of complications compared to single renal artery grafts

Background

Kidney allografts with multiple renal arteries (MRA) are not infrequent and have been historically associated with a higher risk of developing vascular and urologic complications. Reports of kidney transplantation using MRA allografts in the pediatric population remain scarce. The aim of this study was to evaluate if transplantation of allografts with MRA with a surgical intent of creating a single arterial inflow using vascular reconstruction techniques when required, and without the routine use of surgical drains or ureteral stents, is associated with an increased risk of complications when compared to single renal artery (SRA) grafts.

Methods

We retrospectively analyzed all pediatric renal transplant recipients performed by a single surgeon at our center between January 2015 and June 2022. Donor and recipient demographics, intraoperative data, and recipient outcomes were included. Recipients were divided into two groups based on SRA vs. MRA. Baseline variables were described using frequency distributions for categorical variables and means and standard errors for continuous variables. Comparisons of those distributions between the two groups were performed using standard chi-squared and t-tests. Time-to-event distributions were compared using the log-rank test.

Results

Forty-nine pediatric transplant recipients were analyzed. Of these, 9 had donors with MRA (Group 1) and 40 had donors with SRA (Group 2). Native kidney and liver mobilization was performed in 44.4% (4/9) of Group 1 vs. 60.0% (24/40) of Group 2 cases (p = 0.39). There were no cases of delayed graft function or graft primary nonfunction. No surgical drainage or ureteral stents were used in any of the cases. One patient in Group 2 developed a distal ureter stricture. The geometric mean serum creatinine at 6- and 12-months posttransplant was 0.7 */ 1.2 and 0.9 */ 1.2 mg/dl in Group 1 and 0.7 */ 1.1 and 0.7 */ 1.1 mg/dl in Group 2. Two death-censored graft failures were observed in Group 2, with no significant difference observed between the two groups (p = 0.48).

Conclusions

Our study demonstrates that pediatric renal transplantation with MRA grafts, using a surgical approach to achieve a single renal artery ostium, can be safely performed while achieving similar outcomes as SRA grafts and with a low complication rate.

The Use of Patient-Reported Outcome Measures in Daily Clinical Practice of a Pediatric Nephrology Department

(1) Background: Health-related quality of life (HRQoL) is lower in patients with chronic kidney disease (CKD) compared to the general population. In 2011, the KLIK PROM portal was implemented in the Emma Children's Hospital to monitor and discuss HRQoL in daily care. This study describes and assesses the implementation and use of the KLIK PROM portal in the pediatric nephrology department. (2) Methods: CKD patients (self-report, if 8-18 years of age) and their parents (proxy-report, if 1-8 years) were invited to complete HRQoL patient-reported outcome measures (PROMs): TNO-AZL Preschool children Quality Of Life (TAPQOL) or Pediatric Quality of Life Inventory for Children (PedsQL). The PROMs were completed before and discussed during outpatient consultations. The adaptation rate-the proportion of patients/parents who were invited and completed at least one PROM-was calculated. Reported HRQoL scores of CKD patients were compared to the general population. (3) Results: In total, 142 patients (proxy- and self-report) were invited, 112 patients completed at least one PROM (adaptation rate 79%). Patients (n = 84 with informed consent for scientific use) with CKD reported lower HRQoL and HRQoL was more often impaired compared to the general Dutch population. (4) Conclusions: The implementation of KLIK was successful and its use is feasible for daily care. Using KLIK, HRQoL problems can be easily identified and monitored.

Considering a COVID-19 vaccine mandate for pediatric kidney transplant candidates

The world continues to face the effects of the SARS-CoV-2 pandemic. COVID-19 vaccines are safe and effective in protecting recipients, decreasing the risk of COVID-19 acquisition, transmission, hospitalization, and death. Transplant recipients may be at greater risk for severe SARS-CoV-2 infection. As a result, transplant programs have begun instituting mandates for COVID-19 vaccine for transplant candidacy. While the question of mandating COVID-19 vaccine for adult transplant candidates has garnered attention in the lay and academic press, these discussions have not explicitly addressed children who may be otherwise eligible for kidney transplants. In this paper we seek to examine the potential ethical justifications of a COVID-19 vaccine mandate for pediatric kidney transplant candidacy through an examination of relevant ethical principles, analogous cases of the use of mandates, differences between adult and pediatric kidney transplant candidates, and the role of gatekeeping in transplant vaccine mandates. At present, it does not appear that pediatric kidney transplant centers are justified to institute a COVID-19 vaccine mandate for candidates. Finally, we will offer suggestions to be considered prior to the implementation of a COVID-19 vaccine mandate.

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

BACKGROUND

It is widely assumed that pediatric solid organ transplantation results in better caregiver-reported outcomes, including reduced caregiver psychological distress and increased child health-related quality of life (HRQOL), yet little empirical evidence of this expectation exists. The current investigation aims to fill this gap and identify key clinical course factors predictive of caregiver-reported outcomes.

METHODS

Forty-nine caregivers of children (M_age  = 10.30 years, SD = 5.43) presenting for kidney, liver, or heart transplant evaluation reported on their psychological distress levels (anxiety, depression, somatization, and global psychological stress) and their children's HRQOL at children's pretransplant evaluations and 6 months post-transplant. Clinical course factors were abstracted via medical chart review.

RESULTS

Caregivers did not report significant changes in their psychological distress from pre- to post-transplant but reported significantly improved child HRQOL across most domains (ds = -.45 to -.54). Higher post-transplant caregiver global psychological distress was predicted by older child age, shorter time since diagnosis, and lower pretransplant caregiver-reported child HRQOL even after controlling for pretransplant caregiver psychological distress. Lower post-transplant child total HRQOL was predicted by more post-transplant hospitalizations even after controlling for pretransplant child total HRQOL.

CONCLUSIONS

These preliminary results indicate pediatric solid organ transplantation was associated with some improved caregiver-reported outcomes, specifically children's HRQOL, but not caregivers' psychological distress. Linear regression models identify several clinical course and pretransplant factors associated with transplantation outcomes. Characterizing how caregivers view their psychological distress levels and children's HRQOL across the transplantation process could inform family-centered holistic care and support caregiver adaptation to transplantation.