Psychiatric Recommendations for Patients Pursing Kidney Transplantation

M. Jesse, A. Eshelman, T. Rosetti, M. Abouljoud, J. Denny, A. Patel, D. Kim.

Transplant Institute, Henry Ford Health System, Detroit, MI.

Meeting: 2015 American Transplant Congress

Abstract number: 499

Keywords: Kidney transplantation, Psychiatric comorbidity, Psychosocial

Introduction: End-stage renal disease patients have high rates of psychiatric and cognitive pathologies. Despite this, renal transplant candidates do not routinely undergo comprehensive psychiatric evaluation. Purpose: To report on psychiatric and cognitive factors and recommendations pre-kidney transplant across three patient groups: referred pre-listing for an identified psychiatric/psychosocial concern (Group 1), listed candidates as part of routine yearly re-evaluation (Group 2), and routine pre-listing for patients 70+yrs old (Group 3). Methods: 369 patients (Group 1, 193 pre-listing referral; Group 2, 99; and Group 3, 77) underwent semi-structured psychiatric evaluation by doctoral level health psychologists specialized in organ transplant, including cognitive screening. Results: Consistent with prior research, a significant proportion of patients (72.6%) displayed some level of cognitive impairment. There were multiple significant differences between groups on recommendations.

Table 1. n(%)

	Group 1	Group 2	Group 3	p
Displays adequate understanding of transplant process	161(83.4)	92(92.9)	68(88.3)	.04
Recommended further education or resources	32(16.6)	7(7.1%)	7(9.1)
No psychotherapeutic/psychiatric medication recommendations	114(59.1)	81(81.8)	70(90.9)	.001
Psychotherapeutic/psychiatric medication evaluation	77(39.9)	18(18.2)	5(6.5)
No cognitive recommendations	77(39.9)	42(42.4)	18(23.4)	.02
Recommendation of accommodation or further cognitive testing	112(58.0)	57(57.6)	57(74.0)
No current substance use	133(68.9)	81(81.8)	66(85.7)	.001
Recommend cessation of tobacco, alcohol, marijuana and/or illicit substances	60(31.1)	18(18.2)	8(10.4)
No substance use treatment recommendations	152(78.8)	91(91.9)	72(93.5)	.001
Recommendations for or verification of substance use treatment	40(20.7)	8(8.1)	2(2.6)
Adequate support for transplant	122(63.2)	78(78.8)	60(77.9)	.003
Support requires further mobilization	71(36.8)	21(21.2)	15(19.5)

However, all three groups displayed additional recommendations. The majority of patients (221, 59.9%) had 2 to 3 recommendations. This number did not change when excluding recommendations for additional education for understanding of the transplant process. Only 9 patients (2.4%) had no additional recommendations. Conclusion: The findings provide support for more in-depth psychosocial assessments as standard clinical protocol as a number of concerning psychiatric and psychosocial factors were identified.

« Back to 2015 American Transplant Congress