Immunosuppressant Neurotoxicity in Liver Transplant Recipients: Clinical Challenges for the Consultation-Liaison Psychiatrist

• Published in: Psychosomatics (Washington, D.C.) Vol. 39; no. 2; pp. 124 - 133
• Main Authors: Strouse, Thomas B., El-Saden, Suzie M., Glaser, Nancy E.M., Bonds, Curley, Ayars, Natalie, Busuttil, Ronald W.
• Format: Journal Article
• Language: English
• Published: Washington, DC Elsevier Inc 01.03.1998; American Psychiatric Press
• Subjects: Adult; Biological and medical sciences; Blindness, Cortical - chemically induced; Blindness, Cortical - diagnosis; Brain Edema - chemically induced; Brain Edema - diagnosis; Cyclosporine - adverse effects; Drug toxicity and drugs side effects treatment; Female; Graft Rejection - prevention & control; Humans; Immunosuppressive Agents - adverse effects; Liver Transplantation - psychology; Magnetic Resonance Imaging; Male; Medical sciences; Middle Aged; Occipital Lobe - diagnostic imaging; Occipital Lobe - pathology; Parietal Lobe - diagnostic imaging; Parietal Lobe - pathology; Pharmacology. Drug treatments; Psychiatry; Referral and Consultation; Tomography, X-Ray Computed; Toxicity: nervous system and muscle; Human; Nervous system diseases; Toxicity; Liver; Transplantation; Homotransplantation; Differential diagnostic; Case study; Chemotherapy; Surgery; Central nervous system disease; Mental disorder; Ciclosporin; Immunosuppressive agent
• ISSN: 0033-3182; 1545-7206
• DOI: 10.1016/S0033-3182(98)71359-3

Neuropsychiatric problems are common among liver transplant recipients, and immunosuppressant neurotoxicity is an important etiologic factor in the posttransplant period. Four typical cases of immunosuppressant neurotoxicity are presented from the clinical experience of the University of California, Los Angeles–Dumont Liver Transplant program. All patients presented with acute behavioral symptoms and received urgent psychiatric consultation; each proved to be suffering from a variant of immunosuppressiverelated neurotoxicity. Correlative neuroimaging studies and descriptions of clinical course are included. Psychiatrists are urged to become familiar with the signs, symptoms, differential diagnosis, neuroimaging findings, and management of immunosuppressive neurotoxicity and secondary psychiatric disorders in solid organ recipients.