The advent of effective immunosuppressive medicines in the mid-1980s, most notably cyclosporine, revolutionized solid-organ transplant surgery. For the ?rst time, survival rates reached acceptable levels and rendered organ transplantation a reasonable, non-experimental standard of medical practice. From the beginning, the immunosuppressive medications were noted to have signi?cant neurological and psychiatric side effects. From that time to this, the neuropsychiatric side effects such as subjective anxiety or jitteriness, along with tremor, have served as endpoints in the clinical titration of the the most frequently used immunosuppressive medications, cyclosporine and tacrolimus. Experience over the past 15 years, however, has established the fact that there are other neuropsychiatric side effects, varying from seizures, stroke, and profound cognitive impairment to very subtle forms of neuropsychiatric dif?culty. Here we present two cases that underwent uncomplicated renal transplantation and after the immunosuppressive therapy, developed psychiatric symptoms. The first case was a 29 year old woman with psychotic mania, and the second was a 25 year old male with severe depression that followed a hypomanic episode (1-3).
Case No 1: A 29 year-old female patient, with a history of kidney transplantation 9 months ago, developed insomnia, nervousness, mobility, speaking too much, aggressive behavior towards her mother at home, destruction of items, thinking people were trying to poison her, self-talk in the office, increased skepticism, left her workplace without permission, angry and rowdy behavior. History: No previous psychiatric treatment. No family history of substance abuse and psychiatric illness. Surgery for kidney transplantation 9 months ago. Twenty mg/day oral olanzapine treatment was started. Mycophenolate Mofetil 1000 mg tb 2*1 07:30 and 19:30, prednisolone 5 mg tb 1*2 07:30, cyclosporine 100 mg tb 1*1 19.30 cyclosporine 100 mg tb 1*1 21:30 therapy was continued. Blood samples for monitoring of cyclosporine levels were sent outside the center. MPPI, Rorschach, and psychometric examinations were performed and she was evaluated in the direction of psychotic process. PMA is returning to normal; irritability and the patient's insight improved on olanzapine 20 mg/day treatment and she was discharged.
Case No 2: A 25 year-old, male patient, with a history of kidney transplantation 4 years ago. The symptoms included unhappiness, reluctance, discomfort, passive thoughts of death, and insomnia. Hisstory Kidney transplant in 2007. Approximately 1.5 years ago he had increased speech and movement and affective elation observed indicated a hypomanic episode in the hospital outpatient clinic as the patient was evaluated. Risperidone 2 mg/day treatment was started. Two months ago the patient presented with depressive symptoms and started sertraline 50 mg/day, quetiapine 25 mg/day, 500 mg 2 * 2, Mycophenolate mofetil, prednisolone 5 mg, 1 * 1, tacrolimus 1 mg tb 2 * 2, a month after inpatient treatment, the patient became euthymic, anxiety resolved, and after the disappearance of suicidal ideation the patient was discharged.
References: 1. Trzepacz PT, Brenner R, Van Thiel DH. A psychiatric study of 247 liver transplantation candidates. Psychosomatics 1989;30: 147-153. Bulletin of Clinical Psychopharmacology 2011;21(Suppl. 2):S161