Executive Functioning and Mental Health in Adolescent Kidney Transplant Candidates During the COVID-19 Pandemic

Pediatric patients with kidney failure are at increased risk for executive functioning and mental health concerns. The COVID-19 pandemic induced prolonged global stress, potentially intensifying these concerns for patients. This study aimed to determine if pediatric kidney transplant candidates evaluated during the pandemic exhibited greater executive functioning and mental health concerns compared to candidates evaluated before the pandemic.

We retrospectively evaluated 43 pediatric kidney transplant candidates (ages 3-17) who completed pretransplant neuropsychological evaluations between 2017 and 2022. The cohort was divided into two groups by evaluation era (before pandemic [n = 21]; during pandemic [n = 22]). Executive function and mental health were compared across groups using analysis of variance adjusting for covariates. Analyses were stratified by age at evaluation (adolescents: 13-17; preadolescents: 3-12 years), and age-by-era interaction was assessed.

Our cohort included 23 adolescents (M_age = 15.4 years, SD = 1.2) and 20 preadolescents (M_age = 8.8 years, SD = 3.3); 56% of candidates were female and 67% were white. The associations between era and emotional regulation, cognitive regulation, internalizing, and externalizing mean scores were significantly modified by age (interaction p-values < 0.05). Adolescents, but not preadolescent candidates, evaluated during the pandemic showed significantly greater difficulties with emotional regulation (adjusted (adj) mean difference: -14.3; p = 0.01), cognitive regulation (adj difference: -15.7; p = 0.003), internalizing (adj difference: -15.8; p = 0.0008); and externalizing concerns (adj difference: -9.6; p = 0.009) versus adolescents evaluated before the pandemic.

Adolescent candidates evaluated during the COVID-19 pandemic had significantly higher executive functioning and mental health concerns compared to those evaluated before the pandemic; however, no significant differences were found in the mean scores for preadolescent candidates.