Survivorship interventions after liver transplantation (LT): A systematic review of interventions targeting physical and psychosocial wellbeing after LT.

Abstract

Background: Despite improved survival, liver transplantation (LT) recipients need interventions that promote survivorship including better quality of life. This scoping review describes the goals and quality of existing post-LT interventions to identify gaps in post-LT care.

Methods: Published manuscripts and registered clinical trials were identified using MEDLINE, PsychINFO, Cochrane and Scopus from inception to January 1, 2024. Articles and trials were included if they described patient-facing interventions targeting health behaviors, patient-centered outcomes, or preventative health. Data extraction and intervention quality were assessed using applicable trial standards.

Results: A total of 61 published manuscripts and 18 registered trials were identified in: 1) alcohol (n=14), 2) diet/nutrition (n=7), education (n=5), symptom management (n=11), preventative health (n=8), physical activity (n=19), and psychosocial issues (n=15). Most interventions were in the early phases of development or pilot testing and targeted the perioperative period up to 1-year post-LT, with fewer interventions targeting >1-year post-LT. There is good evidence to suggest that multidisciplinary programs with integrated psychiatric resources can reduce alcohol relapse post-LT; in-person multimodal interventions including individualized counseling, exercise prescriptions, and educational materials improved strength, body composition and quality of life. Multidisciplinary clinics integrating education, free resources, and clinical exams are beneficial in skin cancer prevention and cardiovascular risk modification. The best supported psychosocial interventions include support groups and in-person individualized counseling. Limited high-quality studies exist in diet/nutrition and education.

Conclusion: For post-LT survivorship interventions, there is wide variation in intervention quality and limited investigation beyond 1-year post-LT. There is good evidence supporting multidisciplinary clinics/programs to prevent alcohol relapse, enhance physical activity, and facilitate cancer screening. There is limited data on promoting post-LT education, as well as social work and caregiver interventions. Future research should consider these areas for study; high quality interventions need to incorporate stakeholder input, target later LT survivorship stages, and apply consistent definitions of patient-centered outcomes using validated measures.