Posttraumatic Stress and Medication Adherence in Pediatric Transplant Recipients
S. Duncan-Park1, L. Danziger-Isakov2, B. Armstrong3, N. Williams4, J. Odim4, E. Shemesh5, S. Sweet6, R. Annunziato1
1Icahn School of Medicine at Mount Sinai and Fordham University, New York, NY, 2Cincinnati Children's Hospital Medical Center, Cincinnati, OH, 3Rho Inc., Durham, NC, 4NIAID, Bethesda, MD, 5Icahn School of Medicine at Mount Sinai, New York, NY, 6Washington University in St. Louis, St. Louis, MO
Meeting: 2021 American Transplant Congress
Abstract number: 706
Keywords: Multicenter studies, N/A, Psychosocial, Risk factors
Topic: Clinical Science » Ethics » Psychosocial and Treatment Adherence
Session Information
Session Name: Psychosocial and Treatment Adherence
Session Type: Poster Abstract
Session Date & Time: None. Available on demand.
Location: Virtual
*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.
To cite this abstract in AMA style:
Duncan-Park S, Danziger-Isakov L, Armstrong B, Williams N, Odim J, Shemesh E, Sweet S, Annunziato R. Posttraumatic Stress and Medication Adherence in Pediatric Transplant Recipients [abstract]. Am J Transplant. 2021; 21 (suppl 3). https://atcmeetingabstracts.com/abstract/posttraumatic-stress-and-medication-adherence-in-pediatric-transplant-recipients/. Accessed November 21, 2024.« Back to 2021 American Transplant Congress