Chronic kidney disease (CKD) is a major global public health concern, and its prevalence ranges from 11.7 to 15.1% worldwide (Lv and Zhang, 2019). Some researchers estimate that over 434 million Asians suffer from CKD, while China exhibits the highest prevalence of the disease, with approximately 159.8 million individuals afflicted (Liyanage et al., 2022). When a patient’s kidney function gradually declines, end-stage renal disease (ESRD) develops. Currently, the most common ESRD treatment options are kidney transplantation, hemodialysis, and peritoneal dialysis. Kidney transplantation is the optimal treatment for patients with ESRD who would otherwise require dialysis (Stoumpos et al., 2015). However, aging is frequently associated with multiple comorbidities and lower physical status, making kidney transplantation candidates less surgically fit (Pravisani et al., 2021). Determining who among older kidney transplant candidates is appropriate for transplantation can be challenging and complex (Concepcion et al., 2016). According to Jankowska et al. (2021), the long-term patient and graft survivals were poorer in the elderly kidney transplant recipients group versus the younger kidney transplant recipients group from the same donor. Additionally, 75% of deceased donor transplant recipients aged 30–49 years are alive after 5 years compared to only 61% for those older than 65 years (Knoll, 2013). Previous research has revealed that the younger are more eligible for transplant than the elderly who have co-morbidities with poor prognosis and more cardiovascular complications predominantly (Singh et al., 2016; Lim et al., 2022). A thorough medical evaluation with particular focus on cardiovascular health must be employed (Concepcion et al., 2016). Therefore, this study chooses the young and middle-aged population as the research object. Although kidney transplant surgery has many benefits, such as improving quality of life and facilitating metabolic function recovery at a lower cost than other renal replacement therapies (Thuret et al., 2016), patients who are unable to manage the postoperative challenges of kidney transplantation face a variety of psychosocial health issues.

The concept of adaptation was originally proposed in the field of biology (Darwin and Field, 2011) but has since been extended to the fields of psychology and nursing, as well as to society at large. Notably, scholars such as Londono and McMillan (2015) used Rodger’s evolutionary perspective to analyze the concept of psychosocial adaptation. Delineating psychosocial adaptation requires an understanding of psychological and social adaptation. According to previous research, “psychological adaptation” is a self-regulating process characterized by the use of psychological defense mechanisms to reduce stress and maintain balance after experiencing setbacks; meanwhile, “social adaptation” involves altering behavior to conform to social expectations in a way that balance the individual’s relationship with their environment (Derogatis, 1986; Livneh and Antonak, 2005; Yao, 2013; Yuan, 2018; Livneh, 2022). Generally, psychosocial adaptation to illness refers to the patient’s emotional experience, self-evaluation, and attitude after illness, as well as the process of adjusting behaviors to various social groups and norms (Yao, 2013; Londono and McMillan, 2015; Xu et al., 2022). The psychosocial adaption of kidney transplant recipients is a dynamic process impacted by a variety of factors and is closely related to quality of life (Pasquale, 2014; Kamran and Ogden, 2016). According to Wurm et al. (2022), kidney transplant recipients have adverse psychosocial experiences after surgery and often have more unmet needs related to equality in healthcare, acceptance, and negative emotion. Indeed, prior research found that the prevalence of anxiety ranged from 25 to 50% among kidney transplant recipients (Fanakidou et al., 2017). Research also indicates that 42.4% of kidney transplant recipients experience moderate-to-severe psychological issues (Tian et al., 2016). Additionally, long-term emotional problems increase the risk of mortality, graft rejection, and readmission (Molnar-Varga et al., 2011; Zelle et al., 2012). Researchers analyzed 29,809 recipients of kidney transplants using the United Network for Organ Sharing database and found that only 47% returned to work 1 year after surgery; such a delay in the resumption of normal activities is bound to have an effect on physical and mental health (Tzvetanov et al., 2014). Further, in China, 61.6% of female kidney transplant recipients experience sexual dysfunction and sexual activity avoidance; a decrease in the level of sexual desire and general dissatisfaction with sexual life can lead to impaired social function and various mental health problems (Gonçalves et al., 2019; Xiao et al., 2021). Therefore, the psychosocial adaptation of young and middle-aged kidney transplant recipients should be explored. In response, this study examined the postoperative psychosocial adaptation of such individuals in China.

“Illness perception” refers to a patient’s cognitive evaluation of their disease, as well as their understanding of the medical condition and its potential consequences throughout the disease course (Broadbent et al., 2015). Positive illness perception is conducive to favorable health outcomes, whereas negative illness perception can impair the individual’s ability to cope with disease and, Consequently, influence their perception of the disease as manageable or dangerous (Bonsaksen et al., 2015; Sawyer et al., 2019). Previous research has revealed that kidney transplant recipients who perceive their condition more negatively report lower quality of life and more maladaptive coping strategies (Knowles et al., 2016; Kalfoss et al., 2019). Additionally, other researchers noted that medication non-compliance was reported by 32.4% of kidney transplant recipients, while having a positive outlook on one’s health improved medication adherence and patient outcomes (Massey et al., 2013; Wang et al., 2022). According to Zelikovsky and Nelson (2021), an adolescent kidney transplant recipient’s negative beliefs and perceptions about their illness negatively impact their well-being beyond the physical effects of their illness and medications. Thus, negative illness perception has a significant impact on patients’ postoperative health outcomes. However, no studies have been done on illness perception and psychosocial adaptation in kidney transplant recipients. Consequently, this study explored young and middle-aged kidney transplant recipients’ illness perceptions at the early postoperative stage to determine whether illness perception influences their psychosocial adaptation.

“Social support” is a multidimensional term that pertains to the availability of social resources in a given circumstance (Cipolletta et al., 2019); notably, it can orginate from a range of sources, including the individual’s family, friends, and colleagues (Zimet et al., 1990). When kidney transplant recipients receive a high degree of family care and social support (from friends, family, etc.), social support can have a buffering effect by regulating stress and anxiety and can thus improve postoperative mental health (Pisanti et al., 2014; Mouelhi et al., 2018). Previous research has shown that good social support can have a positive impact on patients’ quality of life following surgery; indeed, the same holds true for positive illness perception (Li et al., 2016; Sitjar-Suñer et al., 2020). Along these lines, scholars have found that insufficient levels of social support and negative illness perception can worsen the disease prognosis of patients with ESRD (Suarilah and Lin, 2021; Gunarathne et al., 2022). However, the association between illness perception, social support, and psychosocial adaptation among young and middle-aged kidney transplant recipients in the early postoperative period is currently unknown. Consequently, this study hypothesized that social support plays a mediating role between illness perception and psychosocial adaptation. Specifically, we proposed four hypotheses: (1) positive illness perception is positively associated with positive psychosocial adaptation, (2) negative illness perception negatively affects social support, (3) positive social support is positively associated with positive psychosocial adaptation, and (4) negative illness perception negatively and indirectly influences psychosocial adaptation via social support.

To the best of our knowledge, this is the first study to investigate the relationship between illness perception, social support, and psychosocial adaptation in young and middle-aged kidney transplant recipients during the early postoperative period. It clarifies that social support serves as a partial mediator between illness perception and psychosocial adaptation.

Most patients in this study received their kidneys from hospital donations. The postoperative creatinine levels of young and middle-aged kidney transplant recipients were generally stable. In addition, 81.36% of young and middle-aged kidney transplant recipients experienced complications within 1 year post-surgery, which is consistent with previous research, while the readmission rate of kidney transplant recipients within 1 year was 43.2%; the most common complications are infections, diarrhea, and diabetes (Galindo Sacristán et al., 2013; Sharma et al., 2021). As healthcare workers, we can teach patients how to recognize the symptoms of postoperative complications and encourage them to seek medical help as soon as possible.

Furthermore, the psychosocial adaptation score of young and middle-aged kidney transplant recipients after early surgery was (65.18 ± 16.39) (> 50 points), which indicates a negative psychosocial adaptation level. The study population exhibited more negative psychosocial adaptation scores, compared with hemodialysis patients (61.32 ± 16.32), possibly due to individual differences (Vicdan and Karabacak, 2016). Consequently, it is critical for medical staff to use assessment tools to determine the psychosocial adaptation level of young and middle-aged kidney transplant recipients as soon as possible.

Participants’ illness perception score was (38.89 ± 8.84), which indicates a moderately negative level. Our study is the first to reveal that the more positive the illness perception of young and middle-aged kidney transplantation recipients, the better their psychosocial adaptation level. The results of this study are consistent with those of previous studies. For example, according to Marcos et al. (2007), illness identity is associated with emotional and psychosocial adaptation, while having faith in the possibility that treatment will control the illness is associated with positive outcomes. According to Xu et al. (2022), positive illness perception, favorable disease management ability, and family function are conducive to enhancing the psychosocial adaptation level of patients with inflammatory bowel disease. Similarly, patients with hepatitis C who have a positive illness perception are more confident in their abilities to deal with disease-related challenges and have better physical and mental health outcomes (Langston et al., 2018). Conversely, other researchers believe that psychoeducational interventions can reduce the negative illness perception of kidney transplant recipients, hence enhancing medication adherence and quality of life (Látos et al., 2022; Wang et al., 2022). These findings imply that healthcare teams should assist kidney transplant recipients in identifying the causes of their negative illness perceptions and then utilize psychological intervention techniques to help them develop a more positive attitude about their condition; for example, they encourage patients to be optimistic about the future and to feel a sense of control over their lives following transplantation.

This study also revealed that the greater the level of social support for young and middle-aged kidney transplant recipients, the greater their psychosocial adaptation. Patients undergoing kidney transplants face a high risk of developing mental health issues that can negatively impact their quality of life and increase their likelihood of rejection (Chisholm-Burns et al., 2009; Pasquale et al., 2020). Researchers have noted the connection between enhanced family support and patients’ increased self-efficacy and psychosocial adaptation (Choi et al., 2012; Zhang et al., 2019). In order to help kidney transplant recipients improve their self-management skills, prolong graft function, and maintain psychological well-being, clinical nurses should concentrate on meeting their emotional and social support needs (Pisanti et al., 2014; Been-Dahmen et al., 2018). Some researchers have pointed out that through the adoption of a kidney transplant patient support program, sharing disease experiences may improve patients’ postoperative loneliness and assists them in increasing their self-confidence after kidney transplantation (Pomey et al., 2021). Medical staff should provide appropriate medical support services, while clinical nurses should fully mobilize the patient’s family members to encourage them to actively participate in the recovery and care of the kidney transplant recipient.

Moreover, illness perception not only has a direct effect on psychosocial adaptation, but it also has an indirect effect through social support. The Kidney Disease Improving Global Outcomes recommendations specify that all kidney transplant recipients must have induction therapy to prevent rejection, unless the recipient and donor are identical twins (Chadban et al., 2020). Lifetime medicine, frequent follow-ups, and considerable economic burdens affect the physical and psychological health of kidney transplant recipients (Pisanti et al., 2014; Megawati et al., 2019). According to Segal et al. (2021), there is a correlation between illness perception and social support; when illness perception is more negative, the patient’s self-confidence is lower, which makes it more difficult to control the disease, whereas the lack of social support will make it difficult to establish a correct illness perception, resulting in serious psychosocial problems. Accordingly, Grewal et al. (2010) called for a focus on early detection and interventions to enhance patients’ illness perception to simultaneously achieve risk behavior reduction and secondary prevention. The reason for this relationship could be that when young and middle-aged kidney transplant recipients develop a positive and correct illness perception, they can help improve psychosocial adaptability and promote health by strengthening the level of social support (such as from family, friends, medical care, etc.). These are all possible explanations for the correlation between illness perception, social support, and psychosocial adaptation. The results of this study are relevant for medical staff and public health departments seeking to combine the disciplines of medicine and psychology to promote multidisciplinary cooperation while providing an excellent social support system with new perspectives for enhancing postoperative psychosocial adaptation.

In general, the psychosocial adaptation of young and middle-aged kidney transplantation recipients is affected by many factors. The current study employed PAIS-SR, BIPQ, and MSPSS to assess psychological adaptation, illness perception, and social support of 236 kidney-transplant recipients. The statistical analyses performed found a statistically significant correlation between all three variables. A path analysis also revealed that the relationship between illness perception and psychosocial adaptation was partly mediated by social support. These results imply that clinical nurses and psychologists should focus on the psychosocial adaptation of young and middle-aged recipients following early kidney transplantation, particularly those in the early postoperative period(<1 year post-surgery). To prolong graft function, the medical team should educate patients to cooperate in timely check-ups and live a healthy lifestyle. Furthermore, kidney transplant recipients should be guided to develop positive illness perception and identify the sources of negative emotions in the early postoperative period. Simultaneously, multidisciplinary collaborative interventions should be strengthened to assist early kidney transplant recipients in successfully adapting to post-transplant changes, rebuilding social roles, return to work or school as early as possible, and improving their psychosocial adaptation.

To our konwledge, this study is the first to explore the mediating effect of social support on the association between psychological adaptation, and illness perception among young and middle-aged kidney transplantation recipients. Through quantitative analysis, it is expected that medical staff can effectively alter the status of young and middle-aged kidney transplantation recipients’ psychological adaptation through the intervention of mediating variables, to promote their physical and mental health. Nevertheless, this study had some limitations. First, its setting, sample size, and scope were limited in that it was conducted in only one hospital. Second, this study only included young and middle-aged kidney transplant recipients; elderly kidney transplant recipients should be included in future studies. Third, this study was a cross-sectional study. While this approach allows us to determine correlations between variables, it does not offer insights into their causal relationships. A longitudinal study can be added to a future investigation to illustrate the causal relationship more clearly between variables. In addition, longitudinal studies can compare and analyze the variability and trends of psychosocial adaptation at different points in time. Fourth, we only examined the effect of social support on illness perception and psychosocial adaptation. Therefore, it is necessary to include more diverse mediating or moderating factors in future studies.

The datasets presented in this study can be found in online repositories. The names of the repository/repositories and accession number(s) can be found in the article/supplementary material.

The research proposal was approved by the Ethics Committee of the First Affiliated Hospital of China Medical University. Participants provided written informed consent.

NH and AW designed the study, analyzed the data, and revised the manuscript. NH and TC collected the data. NH wrote the manuscript. All authors contributed to the article and approved the submitted version.

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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