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

Aidos Bolatov 1 2 * , Aruzhan Asanova 1, Sholpan Altynova 1
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1 “University Medical Center” Corporate Fund, Astana, Kazakhstan
2 Shenzhen University Medical School, Shenzhen University, Shenzhen, China
* Corresponding Author
J CLIN MED KAZ, Volume 23, Issue 4, pp. 49-59. https://doi.org/10.23950/jcmk/19121
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Author Contributions: Conceptualization, A.B.*, A.A.* and S.A.; methodology, A B., A.A. and S.A.; formal analysis, A.B.; investigation, A.A. and S.A.; resources, A.A. and S.A.; data curation, A.A. and S.A.; writing – original draft preparation, A.B.* and A.A.; writing – review and editing, S.A.; visualization, A.B.; supervision, S.A.; project administration, A.A.; funding acquisition, S.A. All authors have read and agreed to the published version of the manuscript.
*These authors contributed equally and are co-first authors.

Ethics approval consent to participate: The study followed the Declaration of Helsinki and was approved by the Local Bioethics Commission of the “University Medical Center” (Protocol No. 3, 14 July 2023). All participants gave informed consent online or by phone after receiving full study information. Data were collected anonymously, securely stored, and participation was voluntary, with no risk or consequences for withdrawal.

Data availability statement: All raw data underlying the findings of this study can be obtained from the corresponding author upon reasonable request.

Artificial Intelligence (AI) Disclosure Statement: Artificial intelligence was used to translate and edit the text to improve its readability in English, ensure efficient work under human supervision.

ABSTRACT

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.
Keywords: Kidney Transplantation, Anxiety, Quality of Life, Medication Adherence, Waiting Lists, Health Literacy, Patient-Centered Care

CITATION

Bolatov A, Asanova A, Altynova S. Patient-Reported Pre-Transplant Experiences and Psychological Outcomes after Kidney Transplantation: a Structural Equation Modeling Study. J CLIN MED KAZ. 2026;23(4):49-59. https://doi.org/10.23950/jcmk/19121

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