*Purpose: We investigated the relationship between posttraumatic stress symptoms (PTSS), medication adherence, and quality of life (QoL) in adolescent transplant recipients.

*Methods: This protocol of the Clinical Trials in Organ Transplantation in Children Consortium (CTOTC-11, NCT02892266) included solid organ transplant recipients 12 to 17 years old who were prescribed tacrolimus and had received a transplant > 18 months prior to enrollment. Patients and caregivers rated PTSS using the UCLA PTSD Reaction Index (threshold > 35) and Impact of Event Scale (threshold > 18), respectively, at enrollment. Outpatient tacrolimus trough level data were collected for one year (6 months pre- and post-enrollment) to calculate the Medication Level Variability Index (MLVI), a measure of medication adherence.

*Results: MLVI and PTSS were examined in the full sample (n=119, 118 with sufficient levels to calculate MLVI) and a pre-defined subgroup of liver recipients (n=48), as MLVI threshold has been validated in liver recipients only. The sample included liver (39.5%), kidney (28.6%), heart (16.8%), lung (14.3%), and intestine/liver (0.8%) recipients. Nonadherence (MLVI > 2) was identified in 35.6% of patients and 27.1% of liver recipients. Most patients (80.7%) reported exposure to at least one potentially traumatic event (PTE), including illness/medical trauma (53.8%), bereavement (46.2%), bullying (24.4%), and serious accidental injury (15.1%). Above-threshold PTSS was endorsed by 9.2% of the full sample, 12.5% of liver recipients, and 43.7% of caregivers. PTSS and MLVI were significantly correlated only in the liver subgroup (r=0.31, p=.03). In multivariable regression analyses, patient and caregiver posttraumatic stress avoidance symptoms predicted lower QoL (F=12.94, p<.001), but not MLVI (F=0.70, p=0.50); however, only total patient PTSS, rather than avoidance symptoms specifically, were significant in subsequent hierarchical multivariable linear regression analyses (B=-0.78, B=-0.78, p<.001).

*Conclusions: PTEs are common in adolescent transplant recipients; a minority may meet criteria for PTSD. Screening for PTSS to identify nonadherence risk is not warranted; however, addressing PTSS may help improve quality of life. Caregivers are at greater risk for PTSD than patients, and therefore may require their own supports during the post-transplant period.

The writing team acknowledges the important contributions of investigators from participating CTOTC-11 sites.

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