Neuropsychiatric complications of liver and other solid organ transplantation

1. Mental status changes are often the earliest indication of an untoward c omplication after transplantation. These may be obvious, such as hallucinat ions or paranoid delusions, or they may be subtle, appearing as changes in personality or motivation. 2. The three most common categories of neuropsychiatric posttransplant comp lications include the following: (1) concurrent pathological processes, suc h as mass lesion; (2) effects of vasoconstriction secondary to immunosuppre ssive medications; and (3) central nervous system pharmacodynamic effects o f the immunosuppressive medications. 3. This differential diagnosis should guide the history as well as the ment al status and neurological examinations. Suspected acute processes deserve computed tomography scanning. Magnetic resonance imaging, more sensitive to subtle structural change, should be generally reserved for cases suggestin g such chronic change or those in which treatment appears ineffective. 4. Treatment follows the differential diagnosis. Concurrent diagnoses dicta te specific treatment, such as in drainage of a subdural hematoma or admini stration of antibiotics for cerebral abscess. Symptoms referable to vasocon striction suggest switching the primary immunosuppressive agent. Symptoms s uggesting delirium indicate lowering the dosage of immunosuppressive medica tion, as in the case of generalized seizure, or use of very low-dose antips ychotic medication, as in cases of confusion, amotivational states, or pers onality changes.