Post-Traumatic Stress Disorder and Post-Traumatic Growth following Kidney Transplantation

Abstract

Background: Kidney transplantation (KT) is a life-saving therapy for kidney failure. However, KT recipients can suffer from debilitating depression, post-traumatic stress disorder (PTSD), and suicide. 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, predictors, and the impact of PTSD and PTG on post-KT outcomes. We also considered the roles of benefit finding and resilience. Methods: In a literature 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 tended to increase post-KT, resilience remained stable post-KT. Like PTG, resilience was associated with lower psychological distress, and increased treatment adherence and confidence in the healthcare team. Conclusions: PTG, resilience, and benefit finding appear to reduce the risk of PTSD, promote well-being, and reduce risk of graft failure in KT recipients. Future research to better understand these relationships will allow clinicians and researchers to develop interventions to promote PTG, resilience, and benefit finding, and potentially improve post-transplant outcomes such as adherence and reducing risk of organ rejection.

Psychological distress in adults after pediatric kidney replacement therapy

“…At a median age of 25.7 years, 25 out of 42 adults after pediatric transplantation stated that they felt anxiety or were depressed in a study from Kärrfelt et al [29]. On the other hand, it was reported that psychological distress and post-traumatic stress disorder could result in "post traumatic growth", de ned as a positive and motivating psychological chance leading to positive coping strategies [15].…”

“…Other publications have investigated the impact of other chronic diseases on psychological distress in children and adolescents (e.g., cancer, diabetes, liver transplantation, lung transplantation, heart transplantation) [12][13][14]. Additionally, psychological distress had also been studied in adults suffering from chronic kidney failure on dialysis or after being transplanted [15]. However, little is known about psychological distress in adult persons after successful pediatric kidney transplantation during childhood.…”

Wilms Tumor: Updates about Pathogenesis and New Possible Clinical Treatments of the Most Frequent Pediatric Urogenital Cancer: A Narrative Review

“…In more complex cases, irrespective of one's personality framework, the "cancer" event itself can trigger both acute distress (in its mildest forms) and adjustment disorder (following the diagnosis and processing process), all the way up to true post-traumatic stress, especially if the diagnosis is more unfavorable or not adequately managed by the clinical and family network. Therefore, the need to support the patient and family, from the earliest stages of the illness, is central to the healing process (including through cycles of psychotherapy and parental training techniques) and especially in the future perspective, and unfortunately, both in medical practice and in the literature, such profiles are often underestimated or relegated to mere services offered on par with organizational refreshments, effectively distorting the valuable clinical intervention on the cognitive and psychological sphere of the actors involved in the clinical stage [67][68][69][70][71][72][73][74][75].…”