Patient reflections, challenges, and supports related to early liver transplant for severe alcohol-associated liver disease.
Patient reflections, challenges, and supports related to early liver transplant for severe alcohol-associated liver disease.
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DOI：
10.1097/lvt.0000000000000059
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发表时间：
2023-07-01
影响因子：
4.6
通讯作者：
Chander, Geetanjali
中科院分区：
文献类型：
--
作者：
Chen, Po-Hung;Sung, Hannah C.;Punchhi, Gopika;Krach, Michelle;Greenberg, Ross;Gianaris, Kevin;Teles, Mayan;Kaplow, Katya;Wheatley, Jason;Cameron, Andrew M.;Chander, Geetanjali
移植中心通常要求至少戒酒 6 个月，然后才能为酒精相关性肝病提供肝移植。然而，早期肝移植（ELT）——在临床需要时进行移植而不首先满足传统要求——越来越受到关注。在我们的研究中，我们定性评估了 ELT 接受者在酒精相关性肝病、移植和移植后生存方面所面临的挑战和支持。为了根据性别、种族/族裔、年龄、ELT 开始时间和移植前禁欲持续时间使观点多样化，我们有目的地招募 ELT 接受者并进行半结构化访谈。招募一直持续到数据饱和。我们使用归纳主题分析来分析成绩单。我们在 2020 年 6 月至 12 月期间采访了 20 名 ELT 接受者，并在 3 个参与者特征的时间段内确定了主题。患重病之前的生活中出现了三个主题：(1) 酒精是生活中“持续”的一部分，(2) 饮酒对人际关系和工作生活产生负面影响，(3) 感觉“陷入”饮酒的循环中。重病期间出现了两个主题：(4) 健康状况迅速恶化；(5) 医疗护理和 6 个月禁欲要求。最后，在移植后的生活中，出现了 4 个主题：(6) 羞耻感或耻辱感和新的自我价值，(7) 与他人重新联系并重新定义界限，(8) 移植作为清醒的定义点，(9) 与工作相关的挑战。总的来说，参与者对收到生命的礼物表示感谢，并承认他们对新肝脏的责任。 ELT 接受者的经历揭示了与成瘾、支持系统不足和耻辱相关的复杂心理社会挑战，特别是在移植后时期。如果仅仅关注优化患者或移植物的存活，ELT 接受者的护理将是不完整的。
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.