Patient reflections, challenges, and supports related to early liver transplant for severe alcohol-associated liver disease

Abstract

Transplant centers conventionally require at least 6 months of alcohol abstinence before offering liver transplants for alcohol-associated liver disease. However, early liver transplant (ELT)—proceeding with a transplant when clinically necessary without first meeting the conventional requirement—is increasingly gaining attention. In our study, we qualitatively assessed ELT recipients’ perceived challenges and supports regarding alcohol-associated liver disease, transplant, and posttransplant survivorship. To diversify perspectives based on gender, race/ethnicity, age, time since ELT, and pretransplant abstinence duration, we purposively recruited ELT recipients and conducted semistructured interviews. Recruitment continued until data saturation. We analyzed transcripts using inductive thematic analysis. We interviewed 20 ELT recipients between June and December 2020 and identified themes within 3 participant-characterized time periods. Three themes emerged in life before severe illness: (1) alcohol as a “constant” part of life, (2) alcohol use negatively affecting relationships and work life, and (3) feeling “stuck” in the cycle of drinking. Two themes emerged during the severe illness period: (4) rapidity of health decline and (5) navigating medical care and the 6-month abstinence requirement. Finally, in life after transplant, 4 themes emerged: (6) feelings of shame or stigma and new self-worth, (7) reconnecting with others and redefining boundaries, (8) transplant as a defining point for sobriety, and (9) work-related challenges. Overall, participants expressed gratitude for receiving a gift of life and acknowledged their responsibilities to the new liver. ELT recipient experiences reveal complex psychosocial challenges related to addiction, inadequate support system, and stigma, particularly in the posttransplant period. The care of ELT recipients would be incomplete if focused solely on optimizing patient or graft survival.

Early but not easy: Recipients’ experiences of alcohol-associated liver disease and early transplantation

“…Sobriety is more achievable when individuals have social support, treatment psychological comorbidities, meaningful employment, and higher life satisfaction, and many of these themes stand out as central to ELT recipients' well-being after transplantation in this study. [9] Thus, as this paper points out, there is a great need for high-quality multidisciplinary, long-term integrated care to support those with ELT after transplantation.…”

“…[5] Furthermore, the perspectives and experiences of ELT have yet to be described despite the fact that they may differ from those who met traditional 6-month abstinence requirements. [6][7][8] In this issue of Liver Transplantation, Chen et al [9] describe the experiences of 20 ELT recipients with ALD from a single US transplant center who received ELT between 2012 and 2020. In a one-time qualitative interview, the researchers asked the recipients about their posttransplant challenges, relationships, alcohol experiences, and stigma.…”

“…In this issue of Liver Transplantation , Chen et al 9 describe the experiences of 20 ELT recipients with ALD from a single US transplant center who received ELT between 2012 and 2020. In a one-time qualitative interview, the researchers asked the recipients about their posttransplant challenges, relationships, alcohol experiences, and stigma.…”