Although self-management is essential for liver transplant recipients, there is no review that has synthesized findings related to self-management in this population.
Objective:
This narrative review aimed to synthesize the current findings and identify the gaps in knowledge about self-management in liver recipients.
Methods:
A search of PubMed, CINAHL Plus, PsychINFO, ProQuest, and Web of Science was conducted using the following terms: [Self-care OR Self-management OR Health behavior] AND [Liver transplantation]. Peer-reviewed published research articles focusing on self-management of adult recipients were selected. A total of 23 articles were included for review. Two reviewers independently reviewed the full text of selected articles and extracted the data about definitions, measurements, and findings regarding self-management.
Results:
Three areas of self-management were identified, including medication nonadherence (n = 11), alcohol recidivism (n = 11), and health maintenance (n = 5). Reported rates of medication nonadherence ranged from 8% to 66%. Medication nonadherence was related to recipients’ demographic (eg, age or sex), transplant-related (eg, time since transplant), and pretransplant variables (eg, history of substance/alcohol abuse). Reported alcohol recidivism rates ranged from 3% to 95%. Age, pretransplant variables (eg, abstinent time before transplant), and personality disorder were identified to be related to alcohol recidivism after transplant. The health maintenance studies discussed behaviors such as smoking, clinic appointment attendance, or vaccination/health screening behaviors of recipients.
Discussion:
Self-management studies in liver recipients have been narrowly focused on medication nonadherence and alcohol recidivism. To improve self-management in recipients, self-management beyond medication nonadherence and alcohol recidivism should be comprehensively examined.
KimWRLakeJRSmithM. OPTN/SRTR 2013 annual data report: liver. Am J Transplant. 2015;(15 suppl 2):1–28.
2.
NacifLSPinheiroRSde Arruda PécoraRA. Re-transplantation, higher creatinine levels in hepatitis C virus patients, and donor age are predictors of mortality in long-term analysis of late acute rejection in liver transplantation. Ann Transplant. 2017;22:9–16. doi:10.12659/AOT.901010.
3.
DuffyJPKaoKKoCY. Long-term patient outcome and quality of life after liver transplantation: analysis of 20-year survivors. Ann Surg. 2010;252(4):652–661. doi:10.1097/SLA.0b013e3181f5f23a.
4.
AnastácioLRRibeiro HdeSFerreiraLGLimaASVilelaEGToulson Davisson CorreiaMI. Incidence and risk factors for diabetes, hypertension and obesity after liver transplantation. Nutr Hosp. 2013;28(3):643–648. doi:10.3305/nh.2013.28.3.6193.
5.
AkarsuMBakirYKarademirSUnekTBacakogluAAstarciogluI. Prevalence and risk factors for obesity after liver transplantation: a single-center experience. Hepat Mon. 2013;13(8):e7569. doi:10.5812/hepatmon.7569.
6.
Jiménez-PérezMGonzález-GrandeROmonte GuzmánEAmo TrilloVRodrigo LópezJM. Metabolic complications in liver transplant recipients. World J Gastroenterol. 2016;22(28):6416–6423. doi:10.3748/wjg.v22.i28.6416.
7.
D’AvolaDCuervas-MonsVMartíJ. Cardiovascular morbidity and mortality after liver transplantation: the protective role of mycophenolate mofetil. Liver Transpl. 2017;23(4):498–509. doi:10.1002/lt.24738.
8.
ChatrathHBermanKVuppalanchiR. De novo malignancy post liver transplantation: a single center, population controlled study. Clin Transplant. 2013;27(4):582–590. doi:10.1111/ctr.12171.
9.
AkazawaCNishizonoTYamamotoMTeraguchiSHayashiY. Investigation of actual daily lifestyle leading to continuous self-management after living-donor liver transplantation: more than 5 years living with living-donor liver transplantation and emotions of recipients. Jpn J Nurs Sci. 2013;10(1):79–88. doi:10.1111/j.1742-7924.2012.00214.x.
10.
RedmanBK. Patient adherence or patient self-management in transplantation: an ethical analysis. Prog Transpl. 2009;19(1):90–94.
11.
BratzkeLCMuehrerRJKehlKALeeKSWardECKwekkeboomKL. Self-management priority setting and decision-making in adults with multimorbidity: a narrative review of literature. Int J Nurs Stud. 2015;52(3):744–755. doi:10.1016/j.ijnurstu.2014.10.010.
12.
PonticelliCGrazianiG. Education and counseling of renal transplant recipients. J Nephrol. 2012;25(6):879–889. doi:10.5301/jn.5000227.
13.
GreyMSchulman-GreenDKnaflKReynoldsNR. A revised self- and family management framework. Nurs Outlook. 2015;63(2):162–170. doi:10.1016/j.outlook.2014.10.003.
14.
ShivelyMJGardettoNJKodiathMF. Effect of patient activation on self-management in patients with heart failure. J Cardiovasc Nurs. 2013;28(1):20–34. doi:10.1097/JCN.0b013e318239f9f9.
15.
KoDLeeIMuehrerRJ. Informational needs of liver transplant recipients during a two-year posttransplant period. Chronic Illn. 2016;12(1):29–40. doi:10.1177/1742395315601415.
16.
CroninPRyanFCoughianM. Undertaking a literature review: a step-by-step approach. Br J Nurs. 2008;17(1):38–43.
17.
StilleyCSDiMartiniAFde VeraME. Individual and environmental correlates and predictors of early adherence and outcomes after liver transplantation. Prog Transplant. 2010;20(1):58–66; quiz 67.
18.
Telles-CorreiaDBarbosaAMegaIMonteiroE. Psychosocial predictors of adherence after liver transplant in a single transplant center in Portugal. Prog Transplant. 2012;22(1):91–94. doi:10.7182/pit2012569.
19.
DrentGHaagsmaEBGeestSD. Prevalence of prednisolone (non)compliance in adult liver transplant recipients. Transpl Int. 2005;18(8):960–966. doi:10.1111/j.1432-2277.2005.00170.x.
20.
O’CarrollREMcGregorLMSwansonVMastertonGHayesPC. Adherence to medication after liver transplantation in Scotland: a pilot study. Liver Transpl. 2006;12(12):1862–1868. doi:10.1002/lt.
21.
BeckebaumSIacobSSweidD. Efficacy, safety, and immunosuppressant adherence in stable liver transplant patients converted from a twice-daily tacrolimus-based regimen to once-daily tacrolimus extended-release formulation. Transpl Int. 2011;24(7):666–675. doi:10.1111/j.1432-2277.2011.01254.x.
22.
LambaSNagurkaRDesaiKKChunSJHollandBKoneruB. Self-reported non-adherence to immune-suppressant therapy in liver transplant recipients: demographic, interpersonal, and intrapersonal factors. Clin Transplant. 2012;26(2):328–335. doi:10.1111/j.1399-0012.2011.01489.x
23.
EberlinMOttoGKrämerI. Increased medication compliance of liver transplant patients switched from a twice-daily to a once-daily tacrolimus-based immunosuppressive regimen. Transplant Proc. 2013;45(6):2314–2320. doi:10.1016/j.transproceed.2012.10.037.
24.
LieberSRVolkML. Non-adherence and graft failure in adult liver transplant recipients. Dig Dis Sci. 2013;58(3):824–834. doi:10.1007/s10620-012-2412-0.
25.
WangCWangGYiH. Symptom experienced three years after liver transplantation under immunosuppression in adults. PLoS One. 2013;8(11):e80584. doi:10.1371/journal.pone.0080584.
26.
RodrigueJRNelsonDRHantoDWReedAICurryMP. Patient-reported immunosuppression nonadherence 6 to 24 months after liver transplant: association with pretransplant psychosocial factors and perceptions of health status change. Prog Transplant. 2013;23(4):319–328. doi:10.7182/pit2013501.
27.
SerperMPatzerREReesePP. Medication misuse, nonadherence, and clinical outcomes among liver transplant recipients. Liver Transpl. 2015;21(1):22–28. doi:10.1002/lt.24023.
28.
BeresfordTPSchwartzJWilsonDMerionRLuceyMR. The short-term psychological health of alcoholic and non-alcoholic liver transplant recipients. Alcohol Clin Exp Res. 1992;16(5):996–1000. doi:10.1111/j.1530-0277.1992.tb01908.x.
29.
BerlakovichGASteiningerRHerbstFBarlanMMittlböckMMühlbacherF. Efficacy of liver transplantation for alcoholic cirrhosis with respect to recidivism and compliance. Transplantation. 1994;58(5):560–565. doi:10.1097/00007890-199409150-00006.
30.
HowardLFahyTWongPShermanDGaneEWilliamsR. Psychiatric outcome in alcoholic liver transplant patients. QJM. 1994;87(12):731–736.
31.
OsorioRWAscherNLAveryMBacchettiPRobertsJPLakeJR. Predicting recidivism after orthotopic liver transplantation for alcoholic liver disease. Hepatology. 1994;20(1 pt 1):105–110.
32.
GerhardtTCGoldsteinRMUrschelHC. Alcohol use following liver transplantation for alcoholic cirrhosis. Transplantation. 1996;62(8):1060–1063.
33.
FabregaECrespoJCasafontFDe las HerasGde la PenaJPons-RomeroF. Alcoholic recidivism after liver transplantation for alcoholic cirrhosis. J Clin Gastroenterol. 1998;26(3):204–206.
34.
DiMartiniADayNDewMA. Alcohol use following liver transplantation: a comparison of follow-up methods. Psychosomatics. 2001;42(1):55–62. doi:10.1176/appi.psy.42.1.55.
35.
GishRGLeeABrooksLLeungJLauJYMooreDH2nd. Long-term follow-up of patients diagnosed with alcohol dependence or alcohol abuse who were evaluated for liver transplantation. Liver Transpl. 2001;7(7):581–587. doi:10.1053/jlts.2001.25455.
36.
PageauxGPBismuthMPerneyP. Alcohol relapse after liver transplantation for alcoholic liver disease: does it matter?J Hepatol. 2003;38(5):629–634. doi:10.1016/S0.
37.
van der HeideFDijkstraGPorteRJKleibeukerJHHaagsmaEB. Smoking behavior in liver transplant recipients. Liver Transpl. 2009;15(6):648–655. doi:10.1002/lt.21722.
38.
ZeldinGAMaygersJKleinAThuluvathPJ. Vaccination, screening for malignancy, and health maintenance of the liver transplant recipient. J Clin Gastroenterol. 2001;32(2):148–150. doi:10.1097/00004836-200102000-00011.
39.
XingLChenQYLiJNHuZQZhangYTaoR. Self-management and self-efficacy status in liver recipients. Hepatobiliary Pancreat Dis Int. 2015;14(3):253–262. doi:10.1016/S1499-3872(15)60333-2.
40.
BurraPGermaniGGnoatoF. Adherence in liver transplant recipients. Liver Transpl. 2011;17(7):760–770. doi:10.1002/lt.22294.
41.
De GeestSBurkhalterHBogertLBerbenLGlassTRDenhaerynckK. Describing the evolution of medication nonadherence from pretransplant until 3 years post-transplant and determining pretransplant medication nonadherence as risk factor for post-transplant nonadherence to immunosuppressives: the Swiss Transplant Cohort Study. Transpl Int. 2014;27(7):657–666. doi:10.1111/tri.12312.
42.
De BleserLDobbelsFBerbenL. The spectrum of nonadherence with medication in heart, liver, and lung tranplant patients assessed in various ways. Transpl Int. 2011;24(9):882–891. doi:10.1111/j.1432-2277.2011.01296.x.
43.
WengFLChandwaniSKurtykaKMZackerCChisholm-BurnsMADemissieK. Prevalence and correlates of medication non-adherence among kidney transplant recipients more than 6 months post-transplant: a cross-sectional study. BMC Nephrol. 2013;14:261. doi:10.1186/1471-2369-14-261.
44.
PrihodovaLNagyovaIRosenbergerJ. Adherence in patients in the first year after kidney transplantation and its impact on graft loss and mortality: a cross-sectional and prospective study. J Adv Nurs. 2014;70(12):2871–2883. doi:10.1111/jan.12447.
45.
De BleserLMattesonMDobbelsFRussellCDe GeestS. Interventions to improve medication-adherence after transplantation: a systematic review. Transpl Int. 2009;22(8):780–797. doi:10.1111/j.1432-2277.2009.00881.x.
46.
DobbelsFBerbenLDe GeestS. The psychometric properties and practicability of self-report instruments to identify medication nonadherence in adult transplant patients: a systematic review. Transplantation. 2010;90(2):205–219. doi:10.1097/TP.0b013e3181e346cd.
47.
Ursic-BedoyaJFaureSDonnadieu-RigoleHPageauxGP. Liver transplantation for alcoholic liver disease: lessons learned and unresolved issues. World J Gastroenterol. 2015;21(39):10994–11002. doi:10.3748/wjg.v21.i39.10994.
