The Transplant Patient

The transplant patient faces extraordinary challenges in their emotional and social lives as they undergo the physical transformations associated with the transplantation process. The need for an organ transplant may occur acutely or as a consequence of chronic organ insufficiency, each with its own set of biopsychosocial consequences. The interrelationships between physiology and psychological health are important for bodily health. Even immunological functions show links between brain and other body areas that may bridge emotional and physical states in complex and heretofore poorly understood ways. Pharmacological interventions often cross the bloodbrain barrier, causing psychiatric side effects – for example, during uremia or hypocholesterolemia combined with cyclosporine treatment.

Our book opens with a chapter, “The mystique of transplantation: biologic and psychiatric considerations”, by Thomas Starzl, the distinguished pioneer of liver transplantation from the laboratory to the human situation. Starzl traces the history of immunological barriers that were overcome in order to allow orthotopic organ transplantation, including engraftments of kidney, liver, lung, heart, pancreas, intestine and multiple abdominal viscera. He describes bidirectional immunologic confrontation between graft and host and the important discovery of donor leukocyte chimerism in solid organ transplantation, contrasting it with bone marrow transplantation, where host cells are deliberately cytoablated.

The closing chapter, by Maureen Martin, “Current trends and new developments in transplantation”, addresses new approaches to clinical immunosuppression, based on the concept of chimerism, which use bone marrow and stem cell-derived factors combined with solid organ transplantation.