45 What are the psychosocial factors influencing access to kidney transplantation and transplant outcomes for children? A systematic literature review

Abstract

<h3>Introduction</h3> Kidney transplantation is often seen as the gold standard treatment for children and young people (CYP) with End Stage Kidney Disease. However, psychosocial factors have been cited as a barrier to accessing a kidney transplant, although it is unclear what these are. Through a systematic literature review, this study explores the range of psychological and social factors that influence how soon a CYP with ESKD accesses a kidney transplant. This includes factors that influence kidney transplantation outcomes and factors deemed important to patients and their families in terms of their quality of life. <h3>Material and Methods</h3> We included quantitative, qualitative and mixed-method studies that were peer-reviewed and included primary data. Medline, PsycInfo, CINAHL and Web of Science were searched for papers published in English between January 1964 and September 2020. <h3>Results</h3> After removing duplicates, a total of 6235 studies were retrieved through database searches, hand-searching references and consulting experts in the field. Fifty-seven studies remained after full-text screening against inclusion criteria. There were 46 quantitative, 8 qualitative and 3 mixed-method studies. Most study designs were retrospective longitudinal registry studies. Factors influencing access to transplantation included maternal education, social support network and therapy non-adherence. Race, socioeconomic status and geographic remoteness were often cited as contributory factors. Although factors such as anxiety, depression and avoidant coping strategies were described in the literature in relation to patient family experience and wellbeing, evidence linking these with accessibility to, or outcomes of, paediatric kidney transplantation was limited. <h3>Conclusions</h3> Longitudinal and prospective studies are needed to fully assess the relationship between psychological factors and the relationship with social factors and a CYP’s subsequent access to, or outcomes after, kidney transplantation.