Psychological resilience and post-kidney transplant psychosocial outcomes

Introduction: Kidney transplant recipients (KTRs) face significant psychological challenges, with nearly half developing depression over their lifetime. Mental health disorders in KTRs are associated with an increased risk of graft loss and poorer patient outcomes. Psychological resilience (PR) is the ability to adapt positively to adversity, and it has been linked to improved well-being, however, its role in kidney transplantation remains largely unexplored. Understanding resilience in this context may open up possibilities to improve long-term patient outcomes.
Our aim was to assess the associations between psychological resilience and post-transplant outcomes such as depression, pain catastrophizing and health-related quality of life. Additionally, we examined whether demographic variables confound these relationships, with the goal of clarifying the independent contribution of resilience to patient well-being after kidney transplantation.
Methods: We conducted a cross-sectional study at a single center in Montreal, Canada over 6 months. Adult KTRs ≥3 months post-transplant completed validated questionnaires on PR, health-related quality of life, depressive symptoms, and pain catastrophizing.
Results: A total of 248 KTRs participated (47.6% White, 57.7% men). The scales all presented good-excellent reliability and internal consistency. The mean PR score was 72.50 (SD 20.57), which is lower than the general population (82.4, SD 12.8). Fifty-three individuals (21.4%) met criteria for clinically significant depression (PHQ-9 score ≥10). Participants with ≥ College degree had significantly higher PR (β = -11.11, p < 0.001) and participants who were unmarried had significantly higher risk of depression (β = 2.37, p < 0.001). Each 10-point increase in PR score was associated with a 22% reduction in the odds of meeting clinically significant depression scores (adjusted OR 0.78, 95% CI 0.66–0.93). PR was negatively associated with pain catastrophizing (β = -0.066, p = 0.040). Health-related quality of life did not appear to have meaningful associations with resilience (Mental: β = 0.003, p = 0.93; Physical: β = -0.056, p = 0.10). These findings highlight PR as a protective factor against depression and pain-related distress.

Conclusion: This study addresses a critical knowledge gap in transplantation by examining PR as a potential risk-stratification marker for identifying KTRs who are at elevated risk of psychosocial challenges. Our findings suggest that lower resilience may help identify patients at higher risk of psychological decompensation. This supports our goal to further investigate in its use to enable earlier interventions, and to help allocate resources effectively within transplant care.