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Psychiatric Disorders Before and After Living-Related Transplantation

Received November 16, 2001; revised March 2, 2001; accepted March 15, 2001. From the Tokyo Institute of Psychiatry, Tokyo Metropolitan Organization for Medical Research, the Second Department of Surgery, the Department of Pediatric Surgery, Faculty of Medicine, University of Tokyo, Tokyo 156, Japan; and the Massachusetts General Hospital, Harvard Medical School, Boston, MA. Address reprint requests to Dr. Fukunishi, Tokyo Institute of Psychiatry, 2–1–8 Kamikitazawa, Setagaya-ku, Tokyo 156, Japan. E-mail: fukunisi{at}prit.go.jp

The authors examined psychiatric disorders among two samples of patients who underwent living-related transplant (LRT) for kidney and liver failure. The postoperative prevalence of psychiatric disorders for adult transplant recipients was highest the first 3 months posttransplant. The incidence of psychiatric disorders in the adult recipients with living-related liver transplant (LRLT) was higher (54%, 22 of 41) than that of adult recipients with living-related kidney transplant (LRKT) (28%, 65 of 234). Twelve (80%) of the 15 adult LRLT recipients with adult child-to-parent donors exhibited paradoxical psychiatric syndrome (PPS). Among the 12 affected recipients, guilt-based psychiatric disorders of various types occurred despite successful operative outcome for both donor and recipient. The higher rate of psychiatric disorders among adult LRLT recipients was associated with the occurrence of PPS among recipients of an adult-child allograft. These results signal a new challenge for consultation psychiatrists working with transplant patients.

Key Words: Transplant

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