Schizophrenia-like symptoms following living-related partial liver transplantation

A 25-year-old man presented with symptoms of schizophrenia following living-related partial liver transplantation. Since graduating from high school he had been employed in jobs such as gaming parlor clerk. At age 24 years he contracted hepatitis-B through sexual transmission, and the condition became fulminate. He then underwent living-related partial liver transplantation with his elder brother as donor. Following transplantation, the patient was put on an immunosuppressant (tacrolimus hydrate) and a steroid agent (methylprednisolone). At 8 months post-transplantation, he began to display psychomotor agitation and behavior suggesting abnormal experiences and delusions, such as statements that he was being exposed to electromagnetic waves and that he felt compelled to save the world. Violent behavior led to psychiatric assessment and admission to a medical psychiatry unit (MPU). Although the psychomotor excitement was successfully treated, the patient remained emotionally labile and impulsive, and was refractory to treatment. Even limiting the patient's problems to those diagnosed, they were numerous: 1) psychological factors resulting from a history of violent behavior by his father and marital discord between his parents during early childhood, 2) possible onset of schizophrenia, 3) possible use of drugs that can induce schizophrenic symptoms, 4) possible immunosuppressant-induced CNS toxicity, and 5) possible steroid psychosis. Facilities that provide appropriate psychiatric treatment in such cases are nearly nonexistent in Japan. Thus adequate treatment of such patients remains a subject of concern in transplantation medicine.