Do We Need a Predischarge Psychosocial Evaluation? A Case Report on Peri-Allograft Abscess in a Noncompliant Elderly Kidney Transplant Patient

Abstract

Although postrenal transplant surgical site infections are relatively uncommon, we present the case of a 72-year-old diabetic and hypertensive male patient who developed a delayed peri-graft abscess and severe surgical site infection due to a closed drain exit site infection 1 month following a living-related kidney transplant. While the transplant itself was successful and the patient had passed the pretransplant psychosocial evaluation, their post-transplant noncompliance and unresolved social barriers—such as missed outpatient follow-up appointments—significantly contributed to these complications. This case highlights the limitations of relying solely on pretransplant evaluations and, therefore, emphasizes the critical need for a comprehensive predischarge psychosocial assessment. Such an assessment is particularly vital, especially in elderly patients, as it helps identify and address risks for noncompliance and barriers to follow-up care. To address these challenges, we propose implementing a predischarge psychosocial scoring system that evaluates psychological well-being, social support, cognitive function, understanding of the care plan, and potential obstacles. By identifying high-risk patients, this tool can, in turn, guide tailored interventions to improve adherence. Consequently, a structured predischarge assessment system becomes essential for optimizing post-transplant care, enhancing outcomes, and reducing complications.