Transplant: Complications

BK titers high on prograf: can switch from tacrolimus to everolimus + leflunomide

Viral illness: consider holding cellcept, particularly if illness is refractory

• Graft loss can be distressing for some, while for others it is perceived as part of the continuum of their disease

  • Abrupt loss of function tends to be more distressing than experiencing loss of function more gradually

• Wide variability in emotions and adjustments

  • Depression and anxiety may already be present, and may have even been a contributing factor

  • May come with a sense of relief, feeling that they are at the end of a struggle (trying to "save" the kidney)

  • Return to dialysis may bring a more supportive and predictable requirement

• Nonadherence:

  • The term "nonadherence" is preferred over "noncompliance"

    • Adherence is the extent to which a person's behavior - taking medications, following a diet, and/or executing lifestyle changes - corresponds with agreed upon recommendations from a healthcare provider

  • If related to nonadherence, working toward acceptance and self-compassion may be helpful

    • May have significant guild surrounding loss of kidney, especially if from a living related donor

  • For others, this has not been a focus of their psychology care

  • May be an element of responsibility, but graft loss and return to dialysis almost always represents weakness across multiple systems (healthcare, family, school, community)

    • Individual: age, psychosocial functioning, pill fatigue

    • Family: cohesion, resources, problem solving skills

    • Healthcare system: shared decision making, navigation, health disparities

    • Community: social support, school support, resources

• Support after return to dialysis

  • Individualized behavioral health support

  • How to support them in "getting ready to be ready for transplant"

    • Mental/behavioral health treatment

    • Identifying modifiable factors to improve adherence

    • Finding hope and motivation, improving stamina

  • For some, acknowledging potential for poor outcomes

    • E.g., if finding a suitable donor match is anticipated to be difficult

  • Support transition to adult dialysis, if indicated