Patient-Reported Pre-Transplant Experiences and Psychological Outcomes After Kidney Transplantation: A Structural Equation Modeling Study

Background: Kidney transplantation is the preferred treatment for end-stage kidney disease, but long-term success depends not only on graft outcomes, but also on psychological adaptation and treatment adherence. Evidence on the associations between retrospectively reported pre-transplant experiences and post-transplant psychosocial outcomes remains limited, particularly in Central Asia. This study examined the direct and indirect associations of waiting-related emotional burden, satisfaction with pre-transplant care, awareness, and psychological support with post-transplant anxiety, psychological well-being, and ease of treatment adherence among kidney transplant recipients in Kazakhstan.
Methods: A cross-sectional survey was conducted among 223 adult kidney transplant recipients in Kazakhstan. Latent-variable structural equation modeling was performed in Mplus 8.5 using WLSMV estimation for ordinal indicators. The model included waiting-related emotional burden, satisfaction with pre-transplant care, awareness, anxiety, and well-being as latent constructs.
Results: The model showed acceptable fit (RMSEA=0.068, CFI=0.975, TLI=0.971, SRMR=0.074). Waiting-related burden had the largest standardized association with anxiety (β=0.482, p<0.001) and was also associated with lower well-being (β=-0.304, p=0.001). Anxiety was associated with lower well-being (β=-0.133, p=0.046) and lower perceived ease of treatment adherence (β=-0.306, p<0.001). Waiting-related burden also showed significant indirect associations with lower well-being and lower perceived ease of adherence through anxiety. Pre-transplant care satisfaction was positively associated with awareness and perceived ease of adherence, but also with greater post-transplant anxiety. Awareness was positively associated with well-being, and pre-transplant care satisfaction showed a significant positive indirect association with well-being through awareness. Psychological support during waiting was not associated with anxiety.
Conclusion: Retrospectively reported pre-transplant experiences were associated with post-transplant psychosocial adjustment. Waiting-related burden showed the strongest adverse pattern of associations, whereas awareness was positively associated with well-being. These findings support further prospective evaluation of coordinated psychosocial support before and after transplantation.