Division of Gastroenterology & Hepatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Liver Transpl. 2023 Jul 1;29(7):745-756. doi: 10.1097/LVT.0000000000000059. Epub 2023 Jan 3.
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.
移植中心通常要求在提供酒精相关肝病的肝移植之前至少戒酒 6 个月。然而，早期肝移植（ELT）——在临床需要时进行移植，而无需首先满足传统要求——越来越受到关注。在我们的研究中，我们定性评估了 ELT 受者对酒精相关肝病、移植和移植后生存的感知挑战和支持。为了根据性别、种族/民族、年龄、ELT 后时间以及术前戒酒持续时间的多样性来分散观点，我们有目的地招募了 ELT 受者并进行了半结构化访谈。招募一直持续到数据饱和。我们使用归纳主题分析分析转录本。我们在 2020 年 6 月至 12 月期间采访了 20 名 ELT 受者，并在 3 个参与者特征时间段内确定了主题。在患病前的生活中出现了 3 个主题：（1）酒精是生活的“常态”，（2）饮酒对人际关系和工作生活产生负面影响，（3）感觉“被困”在饮酒循环中。在患病期间出现了 2 个主题：（4）健康状况迅速下降和（5）就医和 6 个月戒酒要求。最后，在移植后的生活中，出现了 4 个主题：（6）感到羞耻或耻辱和新的自我价值感，（7）与他人重新联系和重新定义界限，（8）移植作为戒酒的定义点，以及（9）与工作相关的挑战。总体而言，参与者对获得生命礼物表示感激，并承认自己对新肝脏的责任。ELT 受者的经历揭示了与成瘾、支持系统不足和耻辱感相关的复杂心理社会挑战，尤其是在移植后期间。如果仅关注优化患者或移植物的生存，那么对 ELT 受者的护理将是不完整的。
