Assessment and management of psychosocial challenges in pediatric liver transplantation

Psychosocial risks and, in particular, nonadherence are associated with poor posttransplant outcomes. Psychosocial risks as well as nonadherence may be underrecognized by parents and providers. Therefore, it is important to assess them as a matter of routine rather than to rely on clinical judgment or parent reports alone. The assessment should be developmentally sensitive. Children at different developmental stages face substantially different tasks, including different expectations about disease management. Psychosocial risks can be reliably measured with appropriate validated questionnaires, tests, or interviews. Attempts should be made to address them through the judicious use of transplant clinic personnel as well as mental health providers. Targeted, prospective, multicenter treatment studies are lacking: they would put to rest the question mark that must presently accompany many recommendations in this area. For now, I have attempted to summarize a few general ideas that might be helpful to the practitioner in understanding the role and content of the psychosocial assessment (Table 1). Table 2 summarizes a few points that might be helpful in implementing clinical protocols that target the assessment and treatment of nonadherence.