Recent publications have highlighted the importance of appreciating patients’ nuanced experiences living with decompensated liver disease and after a liver transplant. But attention has been minimal toward the ELT recipient experience: the recognition of the liver disease, transplant process, and posttransplant survivorship. 7, 8 Much of the existing ELT literature has centered around posttransplant outcomes, candidate selection, and policy-centric discussions. 5, 6 Concurrently, the practice has also stimulated ethics debates on issues of justice and utility involving organ allocation for ALD. ![]() Since its introduction a decade ago, ELT for severe ALD has garnered growing interest from liver transplant communities. 3, 4 If necessary, ELT recipients can undergo a majority (or even the entirety) of the alcohol use treatment after their transplants. ![]() Early/expedited liver transplant (ELT) is the practice of proceeding with a transplant-after a meticulous evaluation process-without first meeting the conventional requirement. However, the conventional requirement of a 6-month pretransplant alcohol abstinence period limits some patients’ timely access to the treatment. 2 Liver transplant surgery is a rescue treatment in these high-acuity clinical scenarios. 1 Severe ALD may manifest as acute hepatitis, decompensated cirrhosis, or both. The care of ELT recipients would be incomplete if focused solely on optimizing patient or graft survival.Īlcohol-associated liver disease (ALD) accounts for nearly half of liver-related deaths in the US. ELT recipient experiences reveal complex psychosocial challenges related to addiction, inadequate support system, and stigma, particularly in the posttransplant period. Overall, participants expressed gratitude for receiving a gift of life and acknowledged their responsibilities to the new liver. 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. Two themes emerged during the severe illness period: (4) rapidity of health decline and (5) navigating medical care and the 6-month abstinence requirement. 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. ![]() We interviewed 20 ELT recipients between June and December 2020 and identified themes within 3 participant-characterized time periods. ![]() We analyzed transcripts using inductive thematic analysis. Recruitment continued until data saturation. 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. In our study, we qualitatively assessed ELT recipients’ perceived challenges and supports regarding alcohol-associated liver disease, transplant, and posttransplant survivorship. However, early liver transplant (ELT)-proceeding with a transplant when clinically necessary without first meeting the conventional requirement-is increasingly gaining attention. Transplant centers conventionally require at least 6 months of alcohol abstinence before offering liver transplants for alcohol-associated liver disease.
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