Hong Zhang,1,2 Sai Zhang,2,3 Miao Zhou,1,4 Chunmi Geng,1,4 Xiang Ding2,4,5 

1Teaching and Research Section of Clinical Nursing, Xiangya Hospital, Central South University, Changsha, People’s Republic of China; 2National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, People’s Republic of China; 3Institute of Medical Sciences, Xiangya Hospital, Central South University, Changsha, People’s Republic of China; 4Department of Organ Transplantation, Xiangya Hospital, Central South University, Changsha, People’s Republic of China; 5Liver Cancer Lab, Xiangya Hospital, Central South University, Changsha, People’s Republic of China

Correspondence: Xiang Ding, Email xiangding@csu.edu.cn

Background: Anxiety and depression are highly prevalent and disabling mental disorders that often coexist. Kidney transplant recipients are at high risk of anxiety and depression, especially during the COVID-19 pandemic. However, studies focusing on depression and anxiety among kidney transplant recipients in the post-COVID-19 era are lacking.
Objective: The primary objective of this study was to analyze the prevalence of anxiety symptoms alone (ASA), depressive symptoms alone (DSA), and comorbid anxiety and depressive symptoms (CADS) in kidney transplant recipients after the COVID-19 pandemic. The secondary objective was to identify the risk factors associated with these symptoms.
Methods: A cross-sectional survey was conducted among kidney transplant recipients in a tertiary hospital in Hunan, China, from December 2022 to December 2023. A total of 520 recipients were invited to participate in the survey, and 517 valid questionnaires were obtained (response rate 99.4%). Anxiety and depressive symptoms were assessed using the Self-Rating Anxiety Scale (SAS) and Self-Rating Depression Scale (SDS), based on which participants were divided into four groups: normal (no anxiety or depressive symptoms), ASA, DSA, and CADS. Clinical characteristics were compared between the groups, and the risk factors associated with ASA, DSA, and CADS were analyzed using multiple logistic regression.
Results: Among the 517 kidney transplant recipients enrolled ASA was identified in 3.7% of recipients (n=19), DSA in 20.3% (n=105), and CADS in 13.9% (n=72). Multiple logistic regression showed that rejection was positively associated with ASA, and vaccination was negatively associated with DSA. Younger age, transplant nephritis/nephropathy, a history of postoperative pulmonary infection, and rejection were positively associated with CADS.
Conclusion: In the post-COVID-19 era, our study identifies a high prevalence of anxiety and depressive symptoms among kidney transplant recipients, with multiple associated factors. These findings highlight the urgent need for systematic mental health screening and the development of targeted psychological interventions in transplant care.

Keywords: post-COVID-19 era, kidney transplantation, anxiety, depression, comorbidity