Posttraumatic stress disorder in liver transplant recipients before and after transplantation: prevalence, symptom occurrence, and intrusive memories

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C. Annema, G. Drent, P.F. Roodbol, H.J. Metselaar, B. van Hoek, R.J. Porte, M.J. Schroevers, A.V. Ranchor

Chair(s): M.J.C. Wessels & J.M. Wierdsma

Thursday 9 march 2017

9:24 - 9:36h at Willem Pijperzaal

Categories: Parallel - Verpleegkundig

Parallel session: Parallelsessie X – Verpleegkundig

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Background:
Studies on posttraumatic stress disorder (PTSD) in organ transplant recipients mainly focused on assessing prevalence rates and identifying risk factors. Less is known about which aspects of the transplant process are traumatic in nature. This study aimed at increasing the understanding of PTSD in liver transplant patients by describing the course of PTSD from the waiting-list period up until one year after transplantation, symptom occurrence, psychological co-morbidity, and the nature of re-experiencing symptoms.

Methods:
A prospective cohort study was performed among 95 liver transplant recipients. Data were retrieved by questionnaire before transplantation, and at 3, 6, and 12 months post-transplantation. Both quantitative and qualitative methods were used to analyze the data.

Results:
Before transplantation, 32% of the respondents showed clinically relevant symptoms of PTSD, of which 10.5% fulfilled the criteria of full PTSD and 6.3% fullfilled the criteria of partial PTSD. In all cases, co-morbid conditions of anxiety and/or depression were present. After transplantation, ~15% of the respondents showed clinically relevant symptoms of PTSD, but no new onset of full PTSD was found, while new onset of partial PTSD was found in six respondents. Arousal symptoms, such as sleeping disorders and concentration problems, were the most frequently reported symptoms, but were found not to be distinctive for PTSD in transplant patients because of the overlap with disease- and treatment-related symptoms. Re-experiencing symptoms before transplantation were mostly related to waiting for a donor organ and the upcoming surgery. After transplantation re-experiencing symptoms were mainly related to aspects of the hospital stay, such as the stay on the Intensive Care Unit and experiencing a delirium. 

Conclusions:
In liver transplant patients, clinically relevant PTSD symptomatology is more present than caseness for full and partial PTSD, and both PTSD symptomatology and caseness is more prevalent in liver transplant candidates than in liver transplant recipients during the first year after transplantation. However, because of the overlap with disease and treatment-related factors, and with other psychological disorders, it is difficult to disentangle the differences. Therefore, when PTSD is suspected, referral to a clinician is warranted in order to confirm the diagnosis and subsequently initiate appropriate interventions.