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Immunosuppressant Neurotoxicity in Liver Transplant Recipients

Clinical Challenges for the Consultation-Liaison Psychiatrist

Received February 24, 1997; revised April 16, 1997; accepted July 8, 1997. From the University of California, Los Angeles (UCLA)–Dumont/Cedars-Sinai Combined Liver Transplant Program (TBS, NEMG, RWB); and the Departments of Psychiatry (TBS, NEMG, CB, NA), Radiology (SME), and Surgery (RWB), School of Medicine, UCLA. Address reprint requests to Dr. Strouse, Director, Psychosocial Services, Cedars-Sinai Comprehensive Cancer Center, 8700 Beverly Blvd., Los Angeles, CA 90048. e-mail: tstrouse{at}csccc.salick.com

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 immunosuppressive-related 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.

Key Words: Immunosuppressant • Neurotoxicity • Liver Transplants • Transplantation • Organ Donation

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