DÄ internationalArchive3/2010Psychosocial Aftercare After Organ Transplantation
LNSLNS In addition to the organ pathology following organ transplantation that is described in the article, allotransplantation may be associated with a multitude of psychological stress reactions and disorders.

Physically severely ill patients associate their organ transplantation procedure with their hopes for health and wellbeing. For many patients, the need for lifelong drug treatment, the possibility of organ failure, the damage to other organ systems as a result of immunosuppression, or the associated risk of developing cancer are not compatible with a life free from fear and anxiety and a sufficiently high quality of life. In order to be able to experience the donor organ and the associated lifestyle changes not as a threat but a life enhancing event, patients often need to completely deny the existence of such risks in their everyday lives. The possible result includes problems with adherence, meaning: the ability and willingness of a patient to participate actively in the implementation of a therapeutic regimen. This entails, for example, the reliable administration of the prescribed immunosuppressive drugs. Non-adherence has been shown to be associated with an increased risk for acute rejection, infections, and chronic rejection of the transplanted organ (1, 2).

After a transplantation procedure, the fear of transplant rejection and failure is a stressor that can trigger anxiety related and depressive adjustment disorders after the operation. Equally, psychological acceptance of the donor organ can present a formidable difficulty and may manifest as depressive symptoms or identity disorders. Recent studies have therefore pointed out a need for more psychosocial aftercare in transplant patients (3).
DOI: 10.3238/arztebl.2010.0038a

Dr. med. Uwe Wutzler
Klinik für Psychotherapie und Psychosomatische Medizin
Asklepios Fachklinikum Stadtroda
Bahnhofstraße 1a, 07646 Stadtroda
E-Mail: u.wutzler@asklepios.com

Dr. med. Margit Venner
Institut für Psychotherapie und angewandte Psychoanalyse
Westbahnhofstr. 10
07743 Jena, Germany
Margit.Venner@t-online.de
1.
De Geest S, Abraham I, Moons P et al.: Late acute rejection and subclinical non-compliance with cyclosporine therapy in heart transplant recipients. J Heart Lung Transplantation 1998; 17: 854–63.
2.
Vlaminck H, Maes B, Evers G et al.: Prospective study on late consequences of subclinical non-compliance with immunosuppressive therapy in renal transplant patients. Am J Transplantation 2004; 4: 1509–13.
3.
Schulz KH, Ewers H, Rogiers X, Koch U: Bedarf und Inanspruchnahme psychosozialer Betreuung nach Lebertransplantation. Psychother Psych Med 2007; 57: 221–30.
4.
Schrem H, Barg-Hock H, Strassburg CP, Schwarz A, Klempnauer J: Aftercare for patients with transplanted organs [Nachsorge bei Organtransplantierten]. Dtsch Arztebl Int 2009; 106(9): 148–55.
1. De Geest S, Abraham I, Moons P et al.: Late acute rejection and subclinical non-compliance with cyclosporine therapy in heart transplant recipients. J Heart Lung Transplantation 1998; 17: 854–63.
2. Vlaminck H, Maes B, Evers G et al.: Prospective study on late consequences of subclinical non-compliance with immunosuppressive therapy in renal transplant patients. Am J Transplantation 2004; 4: 1509–13.
3. Schulz KH, Ewers H, Rogiers X, Koch U: Bedarf und Inanspruchnahme psychosozialer Betreuung nach Lebertransplantation. Psychother Psych Med 2007; 57: 221–30.
4. Schrem H, Barg-Hock H, Strassburg CP, Schwarz A, Klempnauer J: Aftercare for patients with transplanted organs [Nachsorge bei Organtransplantierten]. Dtsch Arztebl Int 2009; 106(9): 148–55.