PTSD in solid organ transplant recipients: Current understanding and future implications

Abstract

Posttraumatic stress symptoms (PTSS) are quite prevalent in transplant recipients, although full-scale posttraumatic stress disorder (PTSD) may not be that common. Those symptoms have been linked to poor transplant outcomes, perhaps owing to nonadherence to medications and other recommendations, brought about by the avoidance dimension of the PTSD/PTSS construct (patients may avoid taking their medications because they serve as reminder of the emotionally traumatic event – the transplant). Since it is possible to treat PTSD via specific psychotherapeutic techniques, and the treatment has been shown to be safe and likely effective in other populations, it would appear that the practitioners who treat transplant recipients should be familiar with the presentation and treatment of those symptoms. The present manuscript provides a systematic literature review of the PTSD/PTSS presentation in the pediatric transplant setting, a synthesis of available research findings, and suggestions for current care and future research.

The impact of psychiatric disorders on outcomes following heart transplantation in children

“…A study by Karapolat and colleagues in adult HTx recipients demonstrated that functional capacity correlated with depression and anxiety. and therefore there may be diagnoses relevant to HTx outcomes that were not assessed (ie, post-traumatic stress disorder 44,45 ).…”

“…This, combined with the limitations inherent to ICD coding and variation in the availability of psychiatric resources across centers, likely results in the underestimation of psychiatric diagnoses in our study. It is important to acknowledge that the psychiatric disorders included in our analysis were not exhaustive and therefore there may be diagnoses relevant to HTx outcomes that were not assessed (ie, post‐traumatic stress disorder 44,45 ). Meaningful levels of psychosocial risk also occur in pediatric HTx recipients well‐beyond the transplant admission 46 .…”

Post-traumatic stress disorder in living donors after pediatric liver transplantation

“…Additionally, pediatric recipients are at an important stage of physical and mental development. [13] Some complications may occur after liver transplant. Long-term use of immunosuppressants may also cause side effects to the body.…”

Adherence to Medication During Transition to Adult Services

“…An important area for further consideration is whether posttraumatic stress may be a factor in poor outcomes during transition. Posttraumatic stress symptoms and posttraumatic stress disorder have emerged as risk factors for nonadherence in populations with chronic medical needs [27][28][29][30][31]. Indeed, recent work utilizing a representative sample of the general population demonstrated the profound impact of trauma exposure on functional impairment in those who experienced a traumatic event before the age of 18 years [32].…”

“…Indeed, recent work utilizing a representative sample of the general population demonstrated the profound impact of trauma exposure on functional impairment in those who experienced a traumatic event before the age of 18 years [32]. In the context of special healthcare needs, the avoidance dimension of posttraumatic stress symptoms has been invoked as a potential mechanistic explanation for the reported association between posttraumatic stress symptoms and nonadherence [28,29,31]. Such nonadherence can lead to worsening medical outcomes and complications that, in turn, may lead to re-traumatization and further avoidance [33,34].…”