Karl-Leo Schwering

Long-term psychosocial adjustment following pediatric liver transplantation.

Abstract: This study assessed long‐term psychosocial adjustment to pediatric liver transplantation in 146 patients aged 4–25 yr, who had received a transplant 2–12 yr previously. Evaluations of psychosocial adjustment and related variables were based on the Harter Self‐Perception Profiles for children, Child Behavior Checklist (CBCL), and children’s school level. Up to the age of 8 yr, transplant children as a group did not perceive themselves as less competent than healthy peers. Gender effects were characterized by older girls perceiving significantly less scholastic cognitive competence than their healthy peers. Adolescent and young adult boys had significantly lower global self‐worth and lower perceived athletic competence than their healthy peers. In comparison to normative data of healthy children, CBCL parent‐reported scores revealed significant deficits in competences for all age groups. Only for the older boys, however, did these deficits reported by the parents reach a pathological level. The majority of transplant children also had significantly higher problem scores, but they remained within the normal range, except for the older boys whose internalizing problems reached a borderline level. Our results suggest that liver transplantation does not affect schooling in a substantial way. Regardless of statistically significant differences in psychosocial adjustment, the majority of the transplant children functioned on a normal level. For adolescent and young adult boys, however, the presence of problems and the lack of competences observed by parents and by the youngsters themselves reached borderline to pathological levels. Our findings stress the importance of psychological post‐transplant follow‐up with increased attention of caregivers to child and parental concerns about their long‐term psychosocial adjustment process.

Psychosocial impact of pediatric living‐donor kidney and liver transplantation on recipients, donors, and the family: a systematic review

Living‐donor kidney and liver transplantation intend to improve pediatric recipients’ psychosocial well‐being, but psychosocial impact in recipients strongly depends upon the impact on the donor and the quality of family relations. We systematically reviewed quantitative and qualitative studies addressing the psychosocial impact of pediatric living‐donor kidney and liver transplantation in recipients, donors, and the family. In accordance with the PRISMA guidelines, we systematically searched the databases Medline, Web of Knowledge, Cinahl, Embase, ERIC, and Google Scholar. We identified 23 studies that satisfied our inclusion criteria. Recipients had improved coping skills and satisfactory peer relationships, but also reported anxiety and depressive symptoms, worried about the future, and had a negative body image. Similarly, donors experienced increased self‐esteem, empowerment, and community awareness, but also complained of postoperative pain and a lack of emotional support. With respect to family impact, transplantation generated a special bond between the donor and the recipient, characterized by gratitude and admiration, but also raised new expectations concerning the recipients lifestyle. As psychological problems in recipients were sometimes induced by feelings of guilt and indebtedness toward the donor, we recommend more research on how gift exchange dynamics function within donor–recipient relationships, enrolling donors and recipients within the same study.