Organ Transplantation

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Transplantation engenders many biopsychosocial stressors, resulting in rates of anxiety and mood symptoms, delirium, and cognitive disorders in transplant cohorts that are similar to or higher than rates in other medically ill populations. Untreated psychiatric disorders can impact psychiatric as well as transplant medical outcomes and adherence to necessary posttransplant routines. Pharmacotherapy is an essential component in the psychiatric care of many transplant patients.

Organ disease alters many aspects of drug pharmacokinetics, changing the bioavailability and disposition of medications and both the intended therapeutic action and side effects. For a full review of pharmacokinetics of psychotropic drugs in general and in hepatic, renal, bowel, heart, and lung diseases in particular, the reader is referred to Chapter 1, "Pharmacokinetics, Pharmacodynamics, and Principles of Drug-Drug Interactions," and the respective chapters on these organ systems. Our primary focus for this chapter is on key points in the management of psychopathology in adult transplant patients. Topics include the physiological properties of the newly transplanted organ as this relates to drug pharmacokinetics, the psychopharmacological treatment of psychiatric illness that arises pretransplant to posttransplant, and the neuropsychiatric adverse effects and drug–drug interactions related to immunosuppressant medications. Considering these pharmacological issues and the wide interpatient variability, we provide guidelines for drug choice and dosing.