A qualitative study exploring patients perceived quality of life following an emergency liver transplant for acute liver failure

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

BACKGROUND

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.

PATIENTS AND METHODS

To diversify perspectives based on sex, 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.

RESULTS

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.

CONCLUSIONS

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.

Perspectives of solid organ transplant recipients on medicine-taking: Systematic review of qualitative studies

Medicine-taking among transplant recipients is a complex and ubiquitous task with significant impacts on outcomes. This study aimed to describe the perspectives and experiences of medicine-taking in adult solid organ transplant recipients. Electronic databases were searched to July 2020, and thematic synthesis was used to analyze the data. From 119 studies (n = 2901), we identified six themes: threats to identity and ambitions (impaired self-image, restricting goals and roles, loss of financial independence); navigating through uncertainty and distrust (lacking tangible/perceptible benefits, unprepared for side effects, isolation in decision-making); alleviating treatment burdens (establishing and mastering routines, counteracting side effects, preparing for the unexpected); gaining and seeking confidence (clarity with knowledge, reassurance through collective experiences, focusing on the future outlook); recalibrating to a new normal posttransplant (adjusting to ongoing dependence on medications, in both states of illness and health, unfulfilled expectations); and preserving graft survival (maintaining the ability to participate in life, avoiding rejection, enacting a social responsibility of giving back). Transplant recipients take medications to preserve graft function, but dependence on medications jeopardizes their sense of normality. Interventions supporting the adaptation to medicine-taking and addressing treatment burdens may improve patient satisfaction and capacities to take medications for improved outcomes.

Exploring patients' perceptions and experiences of treatments for the prevention of variceal bleeding: a qualitative study

Background

The most common fatal complication of liver cirrhosis is haemorrhaging caused by variceal rupture. The prevention of the first variceal bleed is, therefore, an important clinical goal. Little is known about patients’ experience of treatments geared towards this, or of their perceptions of treatments prior to being exposed to them.

Aims

To explore the factors impacting patient preference for, and actual experience of carvedilol and variceal band ligation.

Methods

Semistructured interviews were conducted with 30 patients from across the UK at baseline, prior to random allocation to either carvedilol or variceal band ligation. Twenty patients were interviewed a second time at 6-month follow-up. Five patients who declined the trial were also interviewed. Data were analysed using thematic analysis.

Results

There was no clear preference for either treatment pathway at baseline. Key factors reported by patients to influence their treatment preference included: negative experiences with key treatment processes; how long-term or short-term treatment was perceived to be; treatment misconceptions; concerns around polypharmacy and worries around treatment adherence. Patient treatment experience was influenced by their perceptions of treatment effectiveness; clinical surveillance; clinician interaction and communication, or lack thereof. Carvedilol-specific experience was also influenced by the manifestation of side effects and patient dosage routine. Variceal band ligation-specific experience was positively influenced by the use of sedation, and negatively influenced by the procedure recovery period.

Conclusions

These data do not support a view that the patient experience of beta-blockade for prevention of variceal bleeds is likely to be superior to variceal band ligation.

The real experience of patients after liver transplantation in intensive care unit

We aimed to explore the real experience of patients after liver transplantation in the intensive care unit (ICU).Objective sampling method was used to select patients transferred to the ICU in 10 hospitals in Zhuhai from May 2018 to August 2020. Patients need liver transplantation due to advanced liver cancer and decompensated cirrhosis. The eligibility criteria of patients mainly included liver transplant patients who were clear-minded and willing to participate in the study and had stayed in ICU. Phenomenological research methods and in-depth interviews were used in this qualitative study.The results showed that the true experience of patients after liver transplantation during ICU stay was summarized into four themes. The strengths of our qualitative research are that we can find the trend from a phenomenon through interviews and other methods to provide a directional foundation for future quantitative research. Its limitations are that it requires a lot of manpower and time, and its objectivity and universality are limited.Hospitalization experience in the ICU may lead to many negative experiences for liver transplant patients. Nurses should fully understand and pay attention to the psychological changes in patients. Nurses should take effective targeted measures to reduce or eliminate patients' fear of ICU stay and promote rehabilitation.

Liver Transplantation: Recipients' Evaluation of Life From the Perspective of Living Donors

AIM

Liver transplantation affects not only recipients and living donors' lives, but also the nature and quality of their relationship. Moreover, the ways in which recipients of liver transplant experience life and views of living donors on how recipients experience life may differ. These differences may account for relational changes. It is also important to understand how recipients and their living donors' views differ if the aim is to devise psychoeducational programs for recipients and living donors. Therefore, the present study examined the recipients' experience of life after a diagnosis of end-stage liver failure (ESLF) and transplantation surgery from donors' perspective.

METHODS

The sample consisted of 16 living donors who donated a part of their liver to a patient with ESLF. Thematic analysis was undertaken in parallel with interviews during which an interview guide was followed.

FINDINGS

Donors felt that recipients evaluated life after the diagnosis of ESLF and transplantation surgery in terms of limitations, mixed relationships, emotional changes, and improvement in life.

CONCLUSION

Experience of social limitations, negative emotions, and the feeling that one is supported by others could be interpreted in terms of existing psychological theory. Some ways of adjusting that have not been reported before within the context of ESLF extended the literature. These included others being frightened of being infected by ESLF and being insensitive, experience of positive emotions, and ways of improving. Overall, compared with findings of previous qualitative work among recipients, our findings suggest that donors' evaluation of recipients' lives converge with that of recipients.

Effects of a Support Group Intervention on Physical, Psychological, and Social Adaptation of Liver Transplant Recipients

OBJECTIVES

Liver transplant recipients must adapt to a new life after transplant. We report the effects of a support group on physical and psychosocial adaptation of liver transplant recipients.

MATERIALS AND METHODS

The study used a quasi-experimental design, comparing an intervention group and a control group. Data were collected between January 2011 and May 2012 with 73 liver transplant recipients. A patient identification form, Modified Transplant Symptom Occurrence and Symptom Distress Scale - 58, and SF-36 were used for data collection. The intervention group attended support group meetings, while the control group received a routine follow-up. Data were analyzed with t test and The Repeated Measures ANOVA with 1 between-group factor.

RESULTS

The results indicated that the support group intervention increases physical, psychological, and social adaptation of liver transplant recipients. Specifically, this effect of the support group was accrued after support group intervention and decreased 3 months after intervention.

CONCLUSIONS

A support group intervention can have a positive effect on liver transplant recipients' physical, psychological, and social adaptations.

Living with a heart transplant: a phenomenological study

BACKGROUND

Heart transplantation is a relatively new medical treatment for end-stage heart failure. Many studies have addressed the outcomes and the complications and technical problems associated with heart transplants, but few have explored the whole clinical experience of being a heart transplant recipient.

PURPOSE

To understand and gain deeper insight into the lived experience of Iranian heart transplant recipients.

METHODS

Interviews of 11 heart transplant recipients were analyzed according to phenomenological guidelines set forth by Diekelmann.

RESULTS

Six major themes emerged from 29 subthemes, depicting the meaning of living with a transplanted heart. These themes include having a new life, living with new concerns, living with vigilance, paradoxical emotions, bearing others' behaviors, and the prominent role of God in life.

CONCLUSION

Heart transplant recipients in Iran experience a new life in which their faith in God helps them go through hardships and difficulties.

A qualitative analysis of attitudes to face transplants: contrasting views of the general public and medical professionals

While there has been a considerable criticism and debate about face transplantation from ethicists, surgeons and psychologists, little is known about the attitudes of medical professionals and the general public whose support will be necessary if face transplants are to be accepted. This study therefore conducted in-depth, semi-structured interviews with medical professionals (8) and the general public (8) to explore their understanding of and attitudes to face transplants. A thematic analysis was used to analyse these data. Five overarching themes were identified including agreement in principal, caveats and conditions, medical and technical difficulties, function and appearance, and the significance of the human face. The analysis revealed overwhelming support in principle for face transplants, but with important caveats and conditions. Both groups shared clear representations of deserving and undeserving candidates, and concerns about psychological adjustment. The general public sample demonstrated little understanding of medical implications or the consequences of a failed graft, which did concern the medical professionals. Neither group showed a clear understanding of the psychological or social factors required to predict best outcomes and identify suitable candidates. Analyses revealed a stereotypical belief from both groups that the life of a severely disfigured recipient is intolerable without this operation.

Post-traumatic stress disorders, mood disorders, and quality of life in transplant recipients with acute liver failure

OBJECTIVE

The objective of this study was to assess post-traumatic stress disorder (PTSD), depression, anxiety, and quality of life among acute hepatitis patients undergoing liver transplantation.

METHOD

Twenty-four patients underwent transplantation due to acute liver failure. After a brief anamnestic interview to gather demographic and clinical information, each participant underwent a psychological assessment using the SF-36 Health Survey (SF-36), Impact of Events Scale-Revised (IES-R), Hospital Anxiety and Depression (HAD) Scale, as well as Beck Depression Inventory (BDI).

RESULTS

The average age of the patients was 41.17 years (±17.03); the mean time after transplantation was 13.50 ± 13.80 months; 83% of the subjects were women. Anxiety symptoms were observed in 33.2% of the participants and depression in 16.7% by HAD and 45.8% by BDI. By IES-R 46.2% of patients presented high to severe levels of stress. The majority of participants (54.2%) showed good quality of life scores. A correlation analysis indicated a significant negative association between SF-36 score and other scales (from -0.514 to -0.681). Upon a comparative analysis, a significant difference between groups was only noted in SF-36 score (P = .032).

CONCLUSION

The results led us to conclude that anxiety, depression, and PTSD were negatively associated with quality of life in this population. These symptoms also contributed directly to determine well-being among these patients.

Good quality of life after emergency embolisation in postpartum haemorrhage

Twenty-one women, who were treated for postpartum haemorrhage by embolisation of the uterine artery, filled in a series of questionnaires. The questionnaires assessed personality characteristics, illness perceptions, coping and quality of life (QoL). The women also made drawings of their uterus. The results suggest that women who experience emergency embolisation have good QoL at follow-up.

Longitudinal quality of life in liver transplant recipients

More than 75,000 deceased donor liver transplants have been performed in the United States since 1984, thus giving many people another chance at life. Liver transplantation is often scrutinized because of its high cost and limited resources (i.e., organs). Measuring recipient's quality of life posttransplant is one outcome to determine whether liver transplantation is making a difference. Limited information is available from a longitudinal perspective that studies the same recipient over time. The purpose of this study was to describe liver transplant recipients' quality of life pretransplant and 1 and 2 years posttransplant. Patients completed the Quality of Life form at initial evaluation for liver transplant at 1 and 2 years posttransplant. Data from 139 recipients were extracted from a database maintained by a large transplant center in the southwest United States. Repeated-measures analysis of variance showed a statistically significant difference in quality of life at 1 and 2 years posttransplant as compared with quality-of-life scores pretransplant. The major finding was a statistically significant difference in quality of life between men and women, with men reporting higher overall quality-of-life scores. Liver transplantation does make a difference in improving quality of life. Further investigation is suggested to explore the difference of quality of life between genders.

Outcomes of liver transplantation for paracetamol (acetaminophen)-induced hepatic failure

Paracetamol (acetaminophen) hepatotoxicity, whether due to intentional overdose or therapeutic misadventure, is an indication for liver transplantation in selected cases. However, there is a concern that long-term outcomes may be compromised by associated psychopathology that may predispose patients to further episodes of self-harm or poor treatment adherence. We therefore undertook a retrospective analysis of patients transplanted for paracetamol-induced fulminant hepatic failure (FHF) to determine their long-term outcomes, psychiatric problems, and compliance and whether these issues could be predicted from pretransplant information. Records from patients undergoing liver transplantation for paracetamol-associated liver failure in this unit and 2 comparison groups (patients undergoing liver replacement for FHF from other causes and for chronic liver diseases) were examined. Of 60 patients transplanted for paracetamol-induced FHF between 1989 and 2007, 44 (73%) survived to discharge. Currently, 35 patients (58%) are surviving at an average of 9 years post-transplantation. The incidence of psychiatric disease (principally depression) and 30-day mortality were greatest in the paracetamol group, but for those who survived 30 days, there was no difference in long-term survival rates between the groups. Adherence to follow-up appointments and compliance with immunosuppression were lowest in the paracetamol overdose group. Poor adherence was not predicted by any identifiable premorbid psychiatric conditions. Two patients grafted for paracetamol FHF died from self-harm (1 from suicide and 1 from alcoholic liver disease after 5 years). This study suggests that, notwithstanding the shortage of donor liver grafts, transplantation is an appropriate therapy in selected patients, although close follow-up is indicated.