Trauma after the Gift of Life: Identification and Treatment of Post-Traumatic Stress Disorders in Heart Transplant Recipients

Introduction Orthotopic heart transplantation (OHT) recipients have rates of post-traumatic stress disorder (PTSD) over double that of the general population. PTSD after OHT is associated with increased mortality. Use of eye movement desensitization and reprocessing (EMDR) therapy is a novel treatment strategy for PTSD and recently shown to be more effective than cognitive behavioral therapy (CBT). EMDR after OHT has not been reported in the literature. We present two cases that highlight successful use of EMDR therapy post-OHT with improvement of PTSD symptoms. Case Report A 31-year-old female with non-compaction cardiomyopathy occurring during the post-partum period underwent OHT 6 weeks after delivery. Post-OHT course was uncomplicated with no episodes of rejection. Patient treated for depression with sertraline during first year post-OHT. Patient reported symptoms of PTSD with decreased functional capacity. Patient referred for consideration of EMDR therapy, found to be appropriate candidate by psychologist and underwent EMDR. Psychologist reported that patient experienced complete reduction in distress for targets. Patient reported resolution of PTSD symptoms and improved functional capacity. A 52-year-old male with hypertrophic cardiomyopathy underwent OHT, then required second OHT 5 years later due to graft dysfunction from progressive coronary vasculopathy. Course after re-OHT was notable for persistent, moderate cellular rejection requiring treatment with thymoglobulin, increase in baseline oral immunosuppression, and eventual addition of methotrexate. Patient treated for chronic, stable depression with sertraline and CBT. Patient reported symptoms of PTSD, specifically noting fear of needing a third transplant. Patient referred for consideration of EMDR therapy, found to be appropriate candidate by psychologist and underwent EMDR. Psychologist reported patient experienced significant but incomplete reductions in distress for targets and did not complete all sessions of EMDR therapy due to difficulties in the therapy. Patient reported improvement, but not resolution, of his PTSD symptoms. Summary Increased mortality is associated with PTSD after OHT. Therefore, OHT recipients experiencing PTSD symptoms should be referred for further evaluation. Additionally, the use of EMDR therapy could be considered.