Psychosocial Functioning and Quality of Life of Recipients in Pediatric Heart Transplant

Psychosocial functioning and quality of life (QoL) are strongly associated with outcomes in pediatric heart transplant recipients. The data in pediatric transplantation, however, is limited. This study aims to investigate the associations of perioperative anxiety and depression with postoperative complications, sociodemographic and clinical characteristics.

This observational, analytical, longitudinal study included 42 pediatric participants aged 8 to 16 years old. Preoperative psychological assessments were completed by 36 children, the remaining 6 were unable to participate due to invasive ventilation, extracorporeal membrane oxygenation (ECMO), and physical debilitation. Postoperatively, all 42 subjects completed the psychosocial evaluations. Data on recipients characteristics, family characteristics and clinical parameters were collected. Anxiety and depression were assessed using the Screen for Child Anxiety Related Emotional Disorders (SCARED) and the Depression Self-Rating Scale for Children (DSRSC). The Short Form-36 Health Survey (SF-36) was applied to assess the health-related QoL.

Before transplantation, 91.7% (33/36) of the children exhibited symptoms of anxiety, and an identical proportion (91.7%, 33/36) showed signs of depression. After transplantation, the rates of anxiety and depression decreased to 35.7% (15/42) and 11.9% (5/42), respectively. Longer disease course (p = 0.042), preoperative hypoalbuminemia (p = 0.032), older age (p = 0.024), postoperative hypertension (p = 0.011), and postoperative CRRT (p = 0.015) result in depression symptoms. Preoperative hypoalbuminemia (p = 0.032) was also more common in the anxiety group. Additionally, children with psychosocial risks had significantly lower QoL scores in general health (p = 0.008) and mental health (p = 0.015).

Perioperative anxiety and depression are highly prevalent among pediatric heart transplant recipients. Although significant improvements in psychosocial risks were observed at posttransplantation, approximately 40% children continued to experience psychosocial challenges.