Preoperative psychological factors predicting graft rejection in patients undergoing kidney transplant: a pilot study.

Department of Psychiatry and Psychology, Catholic University of Sacred Heart, Rome, Italy.
Transplantation Proceedings (Impact Factor: 0.95). 05/2011; 43(4):1006-9. DOI: 10.1016/j.transproceed.2011.01.158
Source: PubMed

ABSTRACT The aim of this study was to investigate whether pretransplant psychological variables included in the CBA 2.0 Primary Scale-fear, personality, obsessive-compulsive symptoms, state and trait anxiety, psychological reactions, and depression-could predict graft rejection among patients undergoing kidney transplantation.
After ethical committee approval we enrolled 33 consecutive adult patients undergoing kidney transplantation. The inclusion criteria were a stable clinical situation in an out-of-hospital setting; Italian language literacy; a minimum of secondary school-level education, and written informed consent. We excluded patients with a psychotic disturbance, neurocognitive deficit, dementia, serious mental delay (IQ <50), current alcohol or drug abuse, recent ideation or attempted suicide or nonadherence to the therapeutic protocol. Acute and/or chronic graft rejection was diagnosed according to clinical and histopathologic criteria. CBA-2,0 "Primary Scale" series of questionnaires were handed out to patients at the time of the examinations to discrem eligibility for transplantation. Analyses of variance were performed to compare psychological scores among patients with versus without graft rejection. Logistic regression analyses of psychological variables were performed to detect possible predictors for graft rejection. The results of the analysis showed that higher psychoticism scores were able to predict graft rejection (P<.05).
The findings of this study suggest that it is mandatory to preoperatively plan an holistic treatment including psychological intervention mainly focused on psychoticism.

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    ABSTRACT: Transplant patients' representations of their illness, body, and emotional state significantly influence their recovery. In this study, our primary aim was to examine the possible connections between emotional factors, body and illness representations, and renal function after 58 kidney transplantations. To measure mental representations of trans-planted kidneys, we developed a projective drawing test. Other assessment instruments were the Beck Depression Inventory, Spielberger's State and Trait Anxiety Scale, and an in-house questionnaire. We also measured conventional kidney function markers, such as serum creatinine and urea levels. Analysis of our results revealed that patients with higher anxiety levels drew significantly larger kidneys in their projective drawing tests, and displayed significantly higher 10-day creatinine and urea level leading us to consider interrelations of an organ's intrapsychic integration and kidney function. If the graft is not integrated mentally in the body image, the representations of the "foreign body" can be associated with such psycho-neuro-immunologic processes of anxiety, which eventually may lead to adverse physiological effects on kidney function.
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