Psychiatric comorbidities in pediatric organ transplantation: Current findings and clinical approaches

Although pediatric organ transplantation is a critical, life-saving medical intervention that can markedly improve a child’s quality of life, it also presents substantial psychosocial challenges for both children and their parents. Psychiatric comorbidities such as anxiety disorders, depression, post-traumatic stress disorder (PTSD), and delirium are frequently
observed throughout the transplantation process. Contributing factors include medical uncertainties before and after surgery, prolonged hospitalizations, neuropsychiatric effects of immunosuppressive therapy, and social isolation. Parents similarly face high levels of stress, anxiety, and an increased risk of depression, which can negatively affect family dynamics and financial stability. This review examines the most common psychiatric comorbidities in pediatric transplant recipients, their clinical implications and management strategies, as well as parental psychiatric outcomes, family functioning, and related risk factors. The reviewed studies cover patients from various organ transplant groups and different stages of the transplantation process. Despite heterogeneity across findings, consistent evidence highlights the presence of mental health symptoms in both patients and caregivers. In addition to internalizing and externalizing symptoms, cognitive impairments have also been reported. Post-transplant quality of life in pediatric recipients is influenced by parental well-being, family functioning, transplant type, medication adherence, and pre-transplant mental health status. Thus, focusing solely on medical outcomes is insufficient in pediatric organ transplantation. Emphasizing psychiatric evaluation, multidisciplinary collaboration, and access to psychosocial support is essential to improve adjustment and long-term prognosis.