Post-Traumatic Stress Disorder and Post Traumatic Growth Following Kidney Transplantation: A Review

Friday, November 11, 2022

2:15 PM – 3:45 PM

Location: Room 203

Presenting Author(s)

Rebekah Nash, MD, PhD

Assistant Professor
University of North Carolina
Chapel Hill, North Carolina

PDF

Co-Author(s)

Marci Loiselle, PhD

Associate Professor
Duke University Medical Center
Durham, North Carolina
JS

Jessica Stahl, MD

Clinical Assistant Professor
University of North Carolina at Chapel Hill
Chapel Hill, North Carolina
JC

Jamie Conklin, MLIS

Health Sciences Librarian
University of North Carolina at Chapel Hill
Chapel Hill, North Carolina
Terra Rose, PsyD

Assistant Professor
University of North Carolina at Chapel Hill
Chapel Hill, North Carolina
Alissa Hutto, MD (she/her/hers)

Faculty
University of North Carolina
Chapel Hill, North Carolina
DE

Donna Evon, PhD

Professor
University of North Carolina
Chapel Hill, North Carolina
JF

Jennifer Flythe, MD, MPH

Associate Professor
University of North Carolina at Chapel Hill
Chapel Hill, North Carolina
Eileen Burker, PhD

Professor, Director, Clincal Psychologist
University of North Carolina at Chapel Hill
Durham, North Carolina

Abstract: Introduction
Kidney transplantation (KT) is a life-saving therapy for kidney failure. However, over 20% of KT recipients will suffer from debilitating depression, post-traumatic stress disorder (PTSD), or suicidal ideation. Consultation-liaison (CL) psychiatrists and psychologists evaluate prospective KT candidates’ risk for psychiatric co-morbidities and care for recipients whose mental health is interfering with their medical and self-care. In contrast to PTSD, post-traumatic growth (PTG) is a positive psychological change in response to a challenging situation. PTG has been studied in other chronic diseases, but less is known about its role in the setting of KT. We sought to elucidate the prevalence and predictors of PTSD and PTG, and the impact of both on post-KT outcomes. We also considered the roles of two related concepts, benefit finding and resilience, during KT.
Methods
In a systematic review, we identified publications that examined PTSD, PTG, benefit finding, and/or resilience in KT recipients. We excluded case reports and first-person narratives. Publications meeting the specified criteria after full text review underwent data abstraction and descriptive analysis
Results
Of the 1,013 unique citations identified, 39 publications met our criteria. PTSD was the most common construct evaluated (16 publications). Resilience was studied in 11 publications, PTG in nine, and benefit finding in five. Up to 21% of adult and 42% of pediatric KT recipients may experience PTSD, which is associated with lower quality of life (QOL), impaired sleep, and other psychiatric co-morbidity. PTG was associated with improved QOL, kidney function, and reduced risk of organ rejection. While benefit finding became increasingly common over time post-KT, resilience levels remained stable post-KT. Like PTG, resilience was associated with lower psychological distress, and increased treatment adherence and confidence in the healthcare team
Discussion
PTG, resilience, and benefit finding appear to reduce the risk of PTSD and promote well-being in KT recipients. By understanding these relationships, CL psychiatrists and psychologists can develop and evaluate interventions to strengthen patient and caregiver engagement with their care, potentially improving post-transplant outcomes such as adherence and reducing risk of organ rejection.