Transplant as a Medical Trauma: Posttraumatic Stress Symptoms in Pediatric Solid Organ Transplant Patients, a Mixed Methods Approach

Posttraumatic stress symptoms (PTSS) have been reported by pediatric solid organ transplant (SOT) patients well after transplantation. Despite the elevated levels of PTSS in this population, subjective factors associated with PTSS and patients' perception of transplant as traumatic and symptom manifestation of PTSS remains unclear. This study aimed to examine the prevalence of PTSS in pediatric SOT utilizing the DSM-5 PTSD criteria and compare the rate to existing rates in pediatric populations, assess variables associated with PTSS, and explore patients' perception of trauma in SOT and clinical presentation of PTSS. Forty patients participated in the study with twenty-six completing qualitative interviews. One participant (2.5%) met criteria for PTSD with a slightly larger proportion (n=5;12.5%) being characterized as "partial PTSD likely." Clinical elevated symptoms of hyperarousal were most commonly endorsed. The majority of the sample endorsed functional impairment/distress associated with the PTSS. Patients with lifetime trauma exposure and a post-transplant psychiatric diagnosis reported significantly higher PTSS. Greater perceived life threat, treatment intensity, and maladaptive coping strategies were associated with higher PTSS. Post-transplant medical complications was associated with lower post-transplant PTSS. Lastly, patients described various aspects of SOT as traumatic with symptoms being pervasive across life domains. Results indicate subclinical levels of PTSS are prevalent in pediatric SOT patients with some experiencing clinically elevated PTSS. Patients with a post-transplant comorbid psychiatric diagnosis are at-risk and would benefit from transdiagnostic assessment and intervention to address symptoms overlapping across disorders. Post-transplant subjective variables and maladaptive coping strategies appear to be an important component to assess, as it relates to PTSS. Objective variables, such as frequent hospitalizations, may be less suggestive of post-transplant PTSS. In-depth examination of the SOT experience and presentation of PTSS via qualitative methods provides insight into how disruption in adolescents' developmental trajectory due to medical trauma is experienced and manifested.