Of children given a transplant, 65% were diagnosed with at least one lifetime psychiatric disorder, compared with 37.5% of controls (P=0.038), Eric Fombonne, M.D., of McGill University and Montreal Children's Hospital, and colleagues reported online in Pediatric Transplantation.
Transplanted adolescent patients also had more educational and social impairment.
"These dimensions should be routinely screened for in [adolescent] endstage renal disease patients, both before and after transplant, and appropriate steps should be taken when needed," the researchers said.
Children with chronic kidney disease have been shown to have delays in independent behavior, borderline social competence, and tend to be more withdrawn than their peers.
There have been contradictory reports in the literature as to whether kids with chronic kidney disease see improvements in psychological and social function after transplant.
So to describe the psychological profile of transplanted adolescents and to compare it with controls and children with chronic kidney disease the researchers conducted a controlled trial of 100 patients ages 12 to 18 from two medical centers in Montreal.
Patients were divided equally into three groups -- 40 had had transplants, 40 who had chronic kidney disease, and 40 who were healthy matched controls.
Psychiatric symptoms and disorders were evaluated through interviews and self-reported questionnaires.
Those in the transplant group had a significantly higher lifetime incidence of DSM-IV diagnoses, with 65% being diagnosed with at least one lifetime psychiatric disorder, compared with 37.5% in the control group (P=0.038).
The lifetime depressive disorder rate in both the transplant group and in the chronic kidney disease group was 35%, compared with 15.2% in the control group (P=0.043).
Transplant adolescent patients also had significantly more mood disorders than the control group, almost twice the frequency of anxiety disorders, and more behavioral disorders, especially ADHD.
About 23% of the transplant group met diagnostic criteria for ADHD, compared with 5% of the chronic kidney disease group and 7.5% of controls. Boys who'd had a transplant had an especially high rate of the disorder, at 31%.
Learning difficulties were found in 30% of transplanted patients, 15% of chronic kidney disease patients, and 7.5% of controls (P=0.03). About 60% of transplanted patients had repeated at least one school grade, the researchers said.
They noted that the study's small size limited its statistical power, and said that all associations should be "replicated in a larger study before concluding their significance."
In addition, they wrote that "only one investigator did all the K-SADS interviews, which might have led to rater bias." They also noted that "we did not measure important aspects such as health-related quality of life, adjustment to illness, or family functioning."
Still, they concluded that their results "underscore the need for continuous multidisciplinary collaboration in the care of these patients. Because transplant patients face a lifelong disease and may remain at risk for developing psychiatric disorders, special attention should be paid when transferring their care from pediatric to adult services."
|The study was funded by a grant from the Commission de la Recherche, Faculte de Medecine, the Societe Academique Vaudoise, the Fondation du 450eme, and the Department of Psychiatry, Montreal Children's Hospital.
The researchers reported no conflicts of interest.
Zalman S. Agus, MD Emeritus Professor
University of Pennsylvania School of Medicine