Changes in psychosocial adjustment after renal transplantation

Article Abstract:

Kidney transplantation in children is becoming more widely accepted as a treatment for advanced kidney disease. However, there is greater need to understand the psychosocial problems associated with kidney transplantation as experienced by children and their parents. The health and social functioning of children have been reported to improve after transplantation. Some studies found that children who had undergone successful transplants experienced fewer psychosocial problems and more successful rehabilitation than children who were managed by long-term dialysis (artificial filtration of the blood). However, improved adjustment has not been confirmed by comparing children before and after transplantation. Researchers have observed that, after transplantation, some children experience depression, low self-esteem, and poor growth, and become noncompliant with treatment and preoccupied about the side effects of immunosuppressive therapy. In another study, psychosocial adjustment was shown to depend on the stage and severity of renal failure. To learn more about psychosocial adjustment following transplantation, 29 children with advanced kidney disease were assessed before and during dialysis, and after transplantation. In addition, the psychosocial support needed by parents was examined. Most parents perceived that both the child's physical health and behavior, and the quality of family life improved after transplantation. Compared with children receiving dialysis, the parents of children who had kidney transplants had more favorable perceptions of their child's behavioral and emotional adjustment, including psychiatric adjustment, child-rated mood, self-concept, and social functioning. However, children who received transplants tended to have an increased frequency of minor behavioral problems. Their parents required continued psychological and social support as well as attention to their child's medical condition. These findings show that kidney transplantation results in improved psychosocial behavior in children, although parents require continued support in dealing with minor psychological problems. (Consumer Summary produced by Reliance Medical Information, Inc.)

Social aspects, Evaluation, Adjustment (Psychology) in children, Childhood adjustment

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Renal transplantation

Article Abstract:

The impairment of renal (kidney) function progresses through several stages that can be defined by clinical characteristics and remaining kidney function. In chronic renal insufficiency, the function of the kidney has not decreased to less than 30 percent of normal. In chronic renal failure, the function of the kidney has dropped to less than 30 percent of normal and a glomerular filtration rate, or speed at which blood is filtered through the kidney, is less than 15 percent of normal. End stage renal failure is the condition in which kidney transplantation or dialysis, the artificial filtration of blood, is necessary. This advanced stage rarely occurs in children. Birth-related or familial conditions are the major causes of kidney disease leading to chronic renal failure. Dialysis was used more often than kidney transplantation to manage children with end stage real disease between 1981 and 1986. However, the success rate for kidney transplantation from a live donor was 100 percent. Differences between pediatric and adult kidney transplantation include the higher incidence of urological abnormalities in children, more complications with kidneys from children under two years of age, and ethical issues concerning the young patient and the family. Ideally, the human leukocyte antigens (HLA), which are molecular elements on cells that can activate an immune response, should be as similar in both the donor and recipient to prevent rejection of the transplanted kidney. Drugs that suppress the immune system, including prednisolone, cyclosporin, azathioprine, and polyclonal antibody preparations also help to prevent graft rejection. The clinical signs and symptoms, tissue microscopic evidence, and management of graft rejection are discussed. Future developments in kidney transplantation in children are described. (Consumer Summary produced by Reliance Medical Information, Inc.)

Analysis

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Psychological guidelines in the management of paediatric organ transplantation

Article Abstract:

The transplantation of organs is used to treat various life-threatening disorders of childhood. Survival rates at one year after liver transplantation have been estimated at 60 percent. Transplantation of the heart, heart and lung, and kidney have been associated with increasing survival rates in children. The psychological aspects of organ transplantation in children are reviewed. The possible need for transplantation must be discussed with the family. Children should be informed directly about their diagnosis at an early stage of the disease, as this promotes better psychological adjustment in later life. Techniques for informing children of their diagnoses and easing the anxiety of family members are described. After transplantation, psychological problems may arise from: the parents' concern about the environment of the intensive care unit; the loneliness and boredom of a child requiring isolation to prevent infection; and anxiety about rejection of the transplanted organ. Overprotection may also cause problems for the patient after discharge from the hospital, and the medical staff and family must encourage the development of independence in the patient. A major problem in the long-term management of patients with organ transplants is noncompliance with medications that prevent graft rejection, and techniques for improving compliance are described. Children with transplants tend to differ from healthy children in their feelings of self-esteem and body image, and should be encouraged to discuss these issues. Family patterns of interaction must also be re-established after organ transplantation. Continuing psychosocial support should focus on the coping of the family and the development of the child, in addition to medical aspects. (Consumer Summary produced by Reliance Medical Information, Inc.)

Telecommunications systems, Physician and patient, Physician-patient relations, Children

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