Navigating Transplantation: Strategies to Promote Wellness

Kidney transplantation is a journey, both physically and mentally, as patients navigate the road from pretransplant to posttransplant life. It is well known that patients with kidney diseases have higher rates of depression compared with the general population and that depression has been associated with increased morbidity and poor quality of life in patients with chronic kidney disease and kidney failure (1–4).

Transplant psychiatrists are often asked to assess patients with advanced kidney diseases and comorbid mental health disorders to determine transplant candidacy. Common indications for transplant psychiatry referral include:

• extensive mental health history

• active and/or unmanaged mental health symptoms

• complicated psychotropic medication regimens

• history of suicidal ideation, suicide attempts, and/or psychiatric hospitalizations

• active substance use or a history of significant substance use

• active concerns or a significant history of nonadherence

Upon review of the literature pertaining to solid organ transplantation, data exist linking pretransplant mental health diagnoses, particularly depression, with posttransplant nonadherence, higher readmission rates, higher risks of acute rejection and graft loss, and decreased survival; however, not all studies showed that these associations were statistically significant (5–7).

Most transplant centers consider active substance use and unmanaged psychiatric illness to be absolute contraindications to transplantation (8). It is important to note that it is unjust to deny a patient transplantation on the basis of psychiatric diagnosis alone, and longer length of psychiatric symptom stability should be considered a positive prognostic indicator.

Kidney transplantation is associated with improved quality of life and lower rates of psychiatric morbidity compared with dialysis therapies (9–11). However, posttransplant recovery is not without risk of psychiatric complications, including but not limited to depression, anxiety, and posttraumatic stress disorder (12). Posttransplant depression has been linked to higher rates of graft failure and death (13).

Managing physical and mental well-being after transplant is crucial, and it is important for patients to use strategies to promote wellness for the best chance of success after transplant (Figure). These strategies include:

• Building a support system. Recovering from a transplant can present unexpected feelings and emotions. Patients may express feeling overwhelmed while adjusting to a new posttransplant routine, whereas others may endorse the fear of potential unknowns, including possible organ rejection and medical complications. Some individuals experience survivor's guilt toward their deceased donor. It is crucial to solidify an emotional support team of friends and family who are available to openly conversate and process these feelings.

• Communicating with the transplant team. An emotional support team does not need to be exclusive to family and friends; in fact, the transplant team should be an integral part of every patient's support system. Whether it be related to physical symptoms or mental health concerns, it is paramount that patients be communicative and honest with their transplant team to help patients succeed in their recovery. Posttransplant medications can contribute to mood and anxiety, and a dose adjustment may be all that is needed to provide symptom relief.

• Locating kidney transplant support groups. Another supportive option is participation in support groups either through an individual transplant program or through a national kidney or transplant organization. Patients may find added validation and understanding by listening to others’ journeys who have gone through similar experiences.

• Seeking professional mental health treatment. There are circumstances when talking with loved ones or one's transplant team is not enough to provide relief for emotional distress. Meeting with a therapist can provide an additional layer of support while offering a more objective perspective of a patient's situation, or scheduling an appointment with a psychiatrist to determine if psychiatric medications are indicated are both helpful options. Transplant teams are often a good place to start to obtain these referrals.

• Maintaining healthy diet and exercise. Preserving a healthy, balanced diet and participating in regular exercise are always important in promoting physical and emotional wellness. Weight management is also important to reduce long-term medical complications.

• Optimizing quality sleep. After transplant, some medications, including antirejection medications and steroids, can sometimes cause sleep abnormalities such as insomnia and vivid dreams. Sometimes sleep is affected by anxiety and trauma-related symptoms. Practicing optimal sleep hygiene can help with ongoing physical healing while promoting emotional regulation during the day.

• Prioritizing adherence. Following the recommendations of the transplant team is key to success after transplant. This includes adherence with posttransplant medications, attending all medical appointments, and obtaining laboratory work as ordered.

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Strategies to promote wellness after kidney transplantation

Citation: Kidney News 16, 5

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