Mental health & behavioral barriers in access to kidney transplantation: A Canadian cohort study

Istvan Mucsi, Aarushi Bansal, Michael Jeannette, Olusegun Famure, Yanhong Li, Marta Novak, S. Joseph Kim

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Abstract

Background. A history of mental health (MH) disorders or nonadherence (NA) may be barriers to completing the work-up (WU) and/or undergoing kidney transplantation (KT) but this has not been well documented. In this work, we analyzed the relationship between a history of MH disorders or NA and the likelihood of completing the WU or undergoing KT.Methods. Patients referred for KT to the Toronto General Hospital from January 1, 2003, to December 31, 2012, and who completed a social work assessment, were included (n = 1769). The association between the history of MH disorders or NA and the time from referral toWUcompletion or KTwere examined using Cox proportional hazards models. Results. A history ofMHdisorders or NA was present in 24%and 18%, respectively. Patients with MH disorders had a 17%lower adjusted hazard of completing the WU within 2 years of referral (HR 0.83; 95% confidence interval [95% CI], 0.71-0.97). Similarly, patients with a history of NA had a 21% lower hazard of completing the WU (hazard ratio [HR], 0.79; 95% CI, 0.66-0.94). The adjusted HR for KTwas 0.88 (95% CI, 0.74-1.05) and 0.79 (95% CI, 0.64-0.97) for MH disorders and NA, respectively. Conclusions. These findings suggest that a history of MH disorders or NA is a potential barrier to KT.Whether targeted psychosocial support can improve access to KT for these patients requires further study.

Original languageEnglish
Pages (from-to)1182-1190
Number of pages9
JournalTransplantation
Volume101
Issue number6
DOIs
Publication statusPublished - Jan 1 2017

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ASJC Scopus subject areas

  • Transplantation

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