Patient Perspectives on Weight Management and Wellness After Liver Transplantation: A Convergent Mixed Methods Study.

INTRODUCTION

Obesity and metabolic syndrome are common in liver transplant recipients and cause adverse health outcomes. We aimed to elicit patients' perceived barriers and needs for post-transplant weight loss.

METHODS

A convergent mixed methods approach was used to assess attitudes, needs, and barriers to using resources for weight loss. A cross-sectional survey was administered to liver transplant recipients with a body mass index > 25, and focus groups expanded information on topics of interest. Descriptive statistics, Student's t-test, and Wilcoxon rank-sum were used to analyze the survey results, and reflexive thematic analysis was performed for focus groups.

RESULTS

Fifty-three respondents (63.5% male; 88.4% Caucasian; median body mass index 30.7 [27.5, 33.7]) completed the survey (11.9% response rate). The majority (73.6%) believed obesity adversely affected liver grafts. Most patients tried weight loss lifestyle changes (diet modification [86.8%] and exercise [71.7%]). Factors negatively affecting weight management included immunosuppression (49.1%) and fatigue (54.7%). Of the respondents, 42.3% and 18% were likely to consider weight-loss medication and surgery, respectively. Potential liver damage from weight-loss medications (84.9%), medication side effects (60.4%), complications from bariatric surgery (47.1%), and surgery's impact on the transplanted liver (45.2%) were major concerns. Patients were motivated by the care of their transplanted organ when pursuing weight loss and were concerned about interventions that may damage their transplanted liver. Transplant-specific challenges (impact of emotions through the transplant process, physical limitations, and support from peers and health care personnel) were recurring themes.

CONCLUSIONS

Post-transplant patients were largely motivated to lose weight to care for their new liver and concerned about liver damage and side effects when considering medical and surgical weight-loss interventions.