Posttraumatic stress disorder in posttransplant children: creating a clinical program to address their needs

Posttraumatic stress symptoms have been shown to occur in pediatric and adult solid-organ transplant recipients. The presence of these symptoms is associated with non-adherence to medications, increased distress, and poor outcome. Because posttraumatic stress disorder is treatable and because a transplant operation usually is an "anticipated trauma," it is possible to address posttraumatic stress disorder symptoms in transplant recipients and attempt to prevent their development. Under my direction, the pediatric liver transplant program at Mount Sinai Medical Center in New York City created research and clinical programs to address posttraumatic stress symptoms and their consequences. Specifically, the focus on non-adherence to immunosuppressive medications in transplant recipients who are distressed and their parents. This article begins with a review of the data that led to the decision to start these programs. I then present the basic elements that are in place, in this particular program, to address patients' needs. I end this review with preliminary outcome data that illustrate the potential impact of such an integrated approach to patient care on medical outcomes.