Post-Transplant Perspectives Among Alcoholic Liver Disease Patients: Qualitative Interviews to Inform Psychosocial Intervention

Background and Purpose: The purpose of this project was to engage patients who have recently received liver transplantations for alcoholic liver disease (ALD), in order to foster understanding of patients’ experiences, perceived needs, and priorities for substance-related and other psychosocial support services.

People who have undergone liver transplantation (LT) due to ALD have a history of alcohol use disorder and therefore, have a higher risk for return to drinking post-transplant, increasing their risk of mortality, and cost of care. Despite this risk, LT recipients have a demonstrated an aversion to seeking treatment for alcohol use. ALD LT recipients are also at higher risk for mental health issues.  Further, recipients of LT are unlikely to return to work post-transplant and that loss of income or financial stress are difficulties commonly faced by LT recipient. 

This study describes the psychosocial, mental health and substance use characteristics of ALD transplant patients before and after liver transplantation and attempts to understand ALD transplant patient behavioral health help seeking post-transplantation.  

Method: Sixteen people who received a liver transplant secondary to ALD between January 1, 2015 and July 31, 2016 engaged in one semi-structured interview about their experiences prior to, during, and after their liver transplant.  Patients discussed the process they went through physically, emotionally, and financially, as well as their thoughts and experiences regarding substance use.  Interviews were transcribed and thematically coded by two research team members independently.  Results were then reviewed in conference using a general inductive approach.

Results: Patients reported that the transplant itself was a powerful catalyst for healthy lifestyle changes including alcohol abstinence.  Many explained they no longer consider continued alcohol use an option following transplant.  Almost all patients discussed knowing about abstinence requirements, but perceptions of how this rule was applied to their own transplant varied greatly.  ALD patients often reported cognitive impairment, inhibiting their ability to understand information provided to them.  Patients also experienced the need for treatment for alcohol use disorder in distinct ways.  Some individuals reported a high degree of connection to 12-Step approaches, while others felt that 12-Step participation was unnecessary, and were motivated to maintain sobriety by their near-death experience and transplant.  Finally, all patients reported that they relied heavily on their immediate family (spouse, parents, children, or siblings) for support post-transplant.

Implications: Transplant recipients perceive liver transplant as a major turning point.  This may impede engagement in formal substance use treatment if ALD patients see it as unnecessary.  Although substance use treatment planning is common during the process of transplantation, ALD patients are significantly medically compromised and may be limited in their ability to engage in formal treatment.  Since ALD patients rely on familial support, psychosocial interventions should recognize the role of family and be inclusive of primary family supports.