Transplantation Psychiatry: An Overview

Abstract

Psychiatric consultation and evaluation is an important part of candidate selection for organ transplantation. Psychiatric assessment of patients undergoing transplantation procedure is done in pre-and post-transplantation periods, each one having its specifics. In the pre-transplantation period it is crucial to assess the patient's therapeutic adherence and the ability of understanding the treatment. The main prediction factor for short and long-term success is medical compliance for which thorough clarification of psychosocial support is needed. Symptoms of psychological exhaustion due to physical illness should be distinguished from psychiatric disorders. If a patient has a history of psychiatric illness, the risks of exacerbation or recurrence of a disease need to be evaluated. Pharmacokinetic and pharmacodynamics of psychotropic drugs resulting from to organ failure should be considered when deciding on treatment. Psychiatric assessment of the organ donor aims to clarify the psychological suitability and motivation. There are specific aspects of liver, kidney, heart and lung transplantation to keep in mind. Understanding psychosexual development is particularly important to children, before transplantation, as is the assessment of every family member. The consultation concludes with an overall evaluation of the patient's psychosocial strengths and limitations and recommended interventions to optimize the candidacy for transplantation. In the post-transplantation period potential psychological problems or psychiatric disorders must be identified and treated accordingly, in addition to psychiatric side effects of immunosuppressive therapy. The use of psychotropic drugs in the post-transplantation period requires knowledge of medication interactions. Overall, psychiatrists perform multiple roles in the transplantation team. The psychiatrists' goals are to meet the psychological needs of both patients and potential donors, evaluate candidates and to help other medical experts on the team with understanding underlying psychological mechanisms triggered by serious medical conditions and procedures. Finally, the most important purpose is optimal organ recruitment and recovery.

Disparities in Hepatocellular Cancer Screening in Cirrhotic Patients With Psychiatric Disorders

“…Consequently, the proportion of patients undergoing liver transplantation for HCC also did not differ substantially between both groups. Psychiatric disorders are potential contraindications for patients seeking liver transplantation because of drug addiction, therapeutic non-compliance, and limited family or social support [ 21 ]. Further, psychiatric disorders are associated with increased rates of allograft loss and all-cause mortality in cases with HCC [ 22 ].…”

Neuropsychiatric Symptoms after Liver Transplantation in a 65-Year-Old Male Patient

“…Moreover, the use of tacrolimus has been associated with the risk of presenting secondary posterior reversible encephalopathy syndrome, a clinical neuroradiological entity of a benign nature, characterized by neurotoxic effects and mild symptoms such as a headache, tremor, dysesthesia or pseudo-perceptions, and self-limiting course [ 31 ]. Since liver transplant candidates and recipients are at a high risk of psychological distress, the most recent approaches to this topic underline the importance of psycho-social and psychiatric patterns, including the evaluation of the patient’s psychological strengths, limitations, and needs [ 32 , 33 , 34 ]. After the transplant, personalized psycho-social interventions favor recovery processes, improving the quality of life and adherence to immunosuppressants [ 32 , 33 ].…”

“…Since liver transplant candidates and recipients are at a high risk of psychological distress, the most recent approaches to this topic underline the importance of psycho-social and psychiatric patterns, including the evaluation of the patient’s psychological strengths, limitations, and needs [ 32 , 33 , 34 ]. After the transplant, personalized psycho-social interventions favor recovery processes, improving the quality of life and adherence to immunosuppressants [ 32 , 33 ].…”

Older Age in Croatian Clinical Practice is not Discriminative Factor for Liver Transplantation

“…Za dalje poboljšanje posttransplantacijskog preživljenja, uz sve napretke koje donosi razvoj medicinske znanosti, sve veću ulogu imat će socijalna-psihološka potpora bliskog okruženja odnosno obitelji koja je od iznimnog značenja za psihički i tjelesni oporavak nakon kirurškog zahvata (19).…”

“…In the improvement of post-treatment survival, along with all the advantages provided by the development of medical science, the social-psychological support of the environment and the family will have an increasingly important role in postoperative recovery of such patients (19).…”