Do we Treat the Right Patients? Predictors of Psychosocial Treatment Frequencies in a Multimodal Aftercare Program: A KTx360° Substudy

Background. Psychosocial interventions are essential in multimodal aftercare for kidney transplant recipients. However, it remains unclear whether they effectively reach patients with low adherence or elevated mental distress. Methods. We investigated (1) the frequency of suboptimal adherence and mental distress at any point during the aftercare program Kidney Transplantation 360° study (KTx360°), a multicenter, multisectoral, multimodal, telemedicine-based follow-up care model; (2) the rate of psychosocial intervention utilization, and (3) the association between these factors, along with demographic and clinical characteristics, and intervention uptake. This analysis draws on a sample of n = 838 participants. Participants with and without utilization of psychosocial interventions were compared using chi-square tests and Mann-Whitney U tests as appropriate. Logistic regression estimated predictors of utilization. Results. Suboptimal adherence and mental distress were frequently observed in our cohort, affecting 60.6% (n = 508) of participants at some point during the study. Utilization remained limited, with only 27.6% (n = 140) of affected individuals engaging with them. Still, higher levels of suboptimal adherence (ß = 0.48; P = 0.012) and mental distress (depression [ß = 0.74; P < 0.001], anxiety [ß = 0.69; P = 0.001]) were linked to greater intervention use—alongside female sex (ß = –0.43; P = 0.018) and retransplantation status (ß = 0.51; P = 0.034). Conclusions. Even though suboptimal adherence and increased mental distress were associated with a higher utilization of psychosocial intervention, the majority of affected patients were not reached, highlighting a significant gap between need and access. Understanding patterns of utilization is crucial when designing scalable and feasible psychosocial interventions for transplant recipients.