The most significant modifications that need to be made are to the engine mounts, the transmission, and the exhaust system. The engine mounts will need to be changed to accommodate the larger engine, and the transmission will need to be replaced with a transmission compatible with the 6-cylinder engine. The exhaust system will also need to be modified, as the 6-cylinder engine has different exhaust manifolds than the 4-cylinder engine.
In addition to these modifications, it is important to make sure that the engine cooling system and fuel system are sufficient to support the larger engine. The 6-cylinder engine requires a larger radiator and a higher-capacity fuel pump, so these components may need to be replaced or upgraded.
If you are not experienced in performing engine swaps, it is recommended to consult with a mechanic before attempting to fit a six-cylinder engine into your 89 pickup.