The Impact of Stress on the Functioning and Survival of Transplanted Kidneys-Biological Mechanisms, Clinical Implications, and Therapeutic Perspectives.

Stress is well known to affect the immune system. However, in patients suffering from end-stage renal disease (ESRD) who underwent a kidney transplant (KT), the problem of stress appears to still be underestimated. The review aims to discuss the influence of chronic stress on the immune function and the relationship between chronic stress and the fate of a transplanted kidney. Therefore, we analyzed the relevant literature, searching for articles linking chronic stress to kidney transplant. Although the biology of stress is well documented in the literature, its impact on the fate of transplanted kidneys remains poorly understood. We have found only a limited number of studies examining the role of stress in patients after kidney transplantation, especially regarding graft function. However, a few studies have shown that psychological and behavioral interventions appear to reduce perceived stress and improve quality of life among KT patients. Here, we present the Integrated Stress-Immune-Transplant Kidney Model that highlights how stress-related neuroendocrine signals converge with immune and vascular processes to shape chronic immune activation and, ultimately, graft outcomes. It also incorporates behavioral and psychological responses as downstream modulators of the same pathway, rather than parallel or unrelated factors. Addressing this problem in transplant rejection requires an integrative biopsychosocial approach that combines psychological assessment, biological monitoring, and supportive interventions as part of routine post-transplant care.