TY - JOUR
T1 - Posttraumatic stress and medication adherence in pediatric transplant recipients
AU - Duncan-Park, Sarah
AU - Danziger-Isakov, Lara
AU - Armstrong, Brian
AU - Williams, Nikki
AU - Odim, Jonah
AU - Shemesh, Eyal
AU - Sweet, Stuart
AU - Annunziato, Rachel
N1 - Funding Information:
This research was performed as a project of the Clinical Trials in Organ Transplantation in Children, a collaborative clinical research project headquartered at the National Institute of Allergy and Infectious Diseases. The writing team acknowledges the important contributions of investigators from the participating CTOTC‐11 sites: Boston Children’s Hospital – Harvard University, Children’s Hospital of Philadelphia, Children’s Hospital of New York, Cincinnati Children’s Hospital Medical Center, Nationwide Children’s Hospital, Lurie Children’s Hospital of Chicago, Texas Children’s Hospital, Stanford University, Washington University School of Medicine in St. Louis, Mattel Children’s Hospital UCLA, UCSF Medical Center, University of Miami, and University of Texas Southwestern/Children’s Medical Center. The work was supported by NIAID award U01AI077810‐06 (PI: Sweet) and UM2AI117870 (Rho) and NICHD award F31HD096946 (PI: Duncan‐Park).
Funding Information:
This research was performed as a project of the Clinical Trials in Organ Transplantation in Children, a collaborative clinical research project headquartered at the National Institute of Allergy and Infectious Diseases. The writing team acknowledges the important contributions of investigators from the participating CTOTC-11 sites: Boston Children?s Hospital ? Harvard University, Children?s Hospital of Philadelphia, Children?s Hospital of New York, Cincinnati Children?s Hospital Medical Center, Nationwide Children?s Hospital, Lurie Children?s Hospital of Chicago, Texas Children?s Hospital, Stanford University, Washington University School of Medicine in St. Louis, Mattel Children?s Hospital UCLA, UCSF Medical Center, University of Miami, and University of Texas Southwestern/Children?s Medical Center. The work was supported by NIAID award U01AI077810-06 (PI: Sweet) and UM2AI117870 (Rho) and NICHD award F31HD096946 (PI: Duncan-Park).
Publisher Copyright:
© 2021 The American Society of Transplantation and the American Society of Transplant Surgeons
PY - 2022/3
Y1 - 2022/3
N2 - Adolescent transplant recipients may encounter a range of potentially traumatic events (PTEs) pre- and posttransplant, yet little is known about the relationship between posttraumatic stress symptoms (PTSS) and medication adherence in this population. In the present study, adolescent recipients and caregivers completed psychosocial questionnaires at enrollment. Outpatient tacrolimus trough level data were collected over 1 year to calculate the Medication Level Variability Index (MLVI), a measure of medication adherence. Nonadherence (MLVI ≥2) was identified in 34.8% of patients, and most (80.7%) reported ≥1 PTE exposure. Levels of PTSS indicating likely posttraumatic stress disorder (PTSD) were endorsed by 9.2% of patients and 43.7% of caregivers. PTSS and MLVI were significantly correlated in the liver subgroup (r =.30, p =.04). Hierarchical multivariable linear regression analyses revealed overall patient PTSS were significantly associated with QoL (p <.001). PTEs are common in adolescent recipients; a minority may meet criteria for PTSD. PTSS screening to identify nonadherence risk requires further investigation and addressing PTSS may improve QoL. Caregivers appear at greater risk for PTSD and may require their own supports. The study was approved by each participating center's Institutional Review Board.
AB - Adolescent transplant recipients may encounter a range of potentially traumatic events (PTEs) pre- and posttransplant, yet little is known about the relationship between posttraumatic stress symptoms (PTSS) and medication adherence in this population. In the present study, adolescent recipients and caregivers completed psychosocial questionnaires at enrollment. Outpatient tacrolimus trough level data were collected over 1 year to calculate the Medication Level Variability Index (MLVI), a measure of medication adherence. Nonadherence (MLVI ≥2) was identified in 34.8% of patients, and most (80.7%) reported ≥1 PTE exposure. Levels of PTSS indicating likely posttraumatic stress disorder (PTSD) were endorsed by 9.2% of patients and 43.7% of caregivers. PTSS and MLVI were significantly correlated in the liver subgroup (r =.30, p =.04). Hierarchical multivariable linear regression analyses revealed overall patient PTSS were significantly associated with QoL (p <.001). PTEs are common in adolescent recipients; a minority may meet criteria for PTSD. PTSS screening to identify nonadherence risk requires further investigation and addressing PTSS may improve QoL. Caregivers appear at greater risk for PTSD and may require their own supports. The study was approved by each participating center's Institutional Review Board.
KW - clinical research/practice
KW - compliance/adherence
KW - mental health
KW - pediatrics
KW - quality of life (QOL)
KW - social sciences
UR - http://www.scopus.com/inward/record.url?scp=85121345027&partnerID=8YFLogxK
U2 - 10.1111/ajt.16896
DO - 10.1111/ajt.16896
M3 - Article
C2 - 34837457
AN - SCOPUS:85121345027
SN - 1600-6135
VL - 22
SP - 937
EP - 946
JO - American Journal of Transplantation
JF - American Journal of Transplantation
IS - 3
ER -