Changes in Depressive Symptoms Pre- and Post-Kidney Transplantation

Depressive symptoms increased modestly during the first 4 years after kidney transplant but remained below the threshold for clinical depression. Post-kidney transplant Center for Epidemiologic Studies Depression scores improved in recipients with high pre-kidney transplant depressive symptoms. Clinicians should counsel patients on the potential mental health implications of kidney transplant and individualize care decisions accordingly.

Depressive symptoms are common in patients with ESKD and may persist after stopping dialysis because of challenges post-kidney transplant (KT) despite clinical benefits. We sought to assess changes in depressive symptoms pre- and post-KT.

We leveraged a multicenter prospective cohort of 4661 adult (aged ≥18) potential KT candidates and 1215 recipients (2008-2025). Participants reported depressive symptoms via the Center for Epidemiologic Studies Depression (CES-D) scale (range 0-60, high depressive symptoms ≥16) at evaluation, KT, and post-KT. We used linear mixed-effect models to estimate post-KT trajectories of CES-D scores overall and by characteristics at KT admission.

Nineteen percentage of potential candidates at evaluation and 15% of recipients at admission had depressive symptoms; 46% and 38%, respectively, were non-Hispanic Black. Over the first 4 years post-KT, depressive symptoms slightly worsened (slope=0.4 points/yr, 95% confidence interval [CI], 0.3 to 0.6) but remained below the threshold for clinical depression. Post-KT, CES-D score change differed by pre-KT high depressive symptoms score (difference=-1.2 points/yr, 95% CI, -1.8 to -0.6). Specifically, post-KT depressive symptoms were 0.7 points/yr lower (95% CI, -1.2 to -0.1) among recipients with pre-KT high depressive symptoms and 0.5 points/yr higher (95% CI, 0.3 to 0.7) among those without. CES-D score change also differed by preemptive KT status (difference=-0.6 points/yr, 95% CI, -1.0 to -0.1, non-preemptive versus preemptive).

Depressive symptoms worsened slightly over the first 4 years post-KT but remained below the threshold for clinical depression. Notably, post-KT CES-D scores decreased in recipients with high pre-KT depressive symptoms. Clinicians should discuss the mental health impact of KT with patients and tailor care decisions to individual needs.