Patient Undergoing Liver Transplantation: Challenges and Strategies in the Face of the COVID-19 Pandemic

The COVID-19 pandemic created unique risks for liver transplant recipients due to immunosuppression and the higher likelihood of severe outcomes from SARS-CoV-2 infection among people with chronic diseases. These circumstances generated ethical and logistical challenges for patients and care teams, necessitating reorganization of services and vigilant support across the transplant continuum. To better understand risks and guide care, the study asked: what challenges and strategies were experienced by patients undergoing liver transplantation given the risk of contamination by SARS-CoV-2?

Design: Exploratory descriptive qualitative study at a reference center for liver transplantation in southern Brazil. Participants: Adult liver transplant recipients transplanted at the institution between 2011 and 2022; excluded were patients who did not continue follow-up at the institution during the pandemic. Sampling was intentional to include patients at varied postoperative times, not only those transplanted during the pandemic peak. Data collection: Semi-structured interviews conducted June–September 2022, covering patient profile, transplant characteristics, and open-ended questions on challenges and strategies adopted due to the risk of SARS-CoV-2 contamination. Ethics: Informed consent obtained; study approved by the Research Ethics Committee (Certificate 353328621.6.0000.0121; Opinion 5.228.855). Analysis: Transcribed interviews were compared and grouped by similarity of meaning; categories were named and frequencies computed as the number of times certain ideas were mentioned, yielding estimated percentages for challenges and strategies.

- Sample: 23 liver transplant recipients; mean age 62 years; mean MELD score 20. - Support network: 21 (91.3%) had family caregivers during the pandemic. - SARS-CoV-2 infection: 16 (69.5%) reported neither they nor cohabiting family members were infected. - Vaccination: 16 (69.5%) received 3–4 doses. - Challenges reported: - Dependence on others for daily activities: reported by all participants. - Isolation/loneliness/fear: widely reported; fear of dying 12 (52.1%); anxiety, insecurity, stress frequently cited; prolonged isolation causing conflict/stress 8 (34.7%). - Lack of access to the multiprofessional team during the critical period and difficulty obtaining basic information to reduce anxiety: 12 (52.1%). - Financial problems due to stopping work to isolate: 12 (52.1%). - Fear of family members who worked outside bringing infection home: frequently mentioned. - Strategies implemented: - Establishing a support network to perform essential tasks outside the home: 23 (100.0%). - Reducing/spacing clinic appointments and exams; organizing precautionary logistics with the support network for necessary visits: 20 (86.9%). - Home-based precautions (each ~16 participants; 69.5%): reorganizing household space to isolate the transplant recipient; universal masking at home; immediate showering and precautions for household members returning from work; daily cleaning; disinfecting incoming goods with alcohol gel. - Adhering to public health and transplant team guidance, especially strict social isolation.

Social isolation, while effective in reducing contagion, heightened feelings of dependence, loneliness, fear, and anxiety among liver transplant recipients, contributing to emotional and physical burden and potential psychological comorbidities. Findings align with prior studies highlighting the mental health impact of the pandemic on chronically ill and immunosuppressed populations and the need for vigilant, ongoing multiprofessional support. Patients adopted robust coping and logistical strategies—support networks, reduced outings, and rigorous home precautions—to protect themselves, though reliance on support networks could exacerbate feelings of isolation and dependence. The care team faces the ongoing challenge of monitoring for pandemic-related sequelae, including psychological distress, and integrating patient-derived strategies into care to enhance safety and resilience during and after crisis periods. As a qualitative account, the study documents lived experiences to inform more sensitive, patient-centered transplant care.

Dependence on others was the primary challenge reported by all participants, followed by isolation, loneliness, and fear. Establishing a support network to accomplish basic tasks was the principal strategy reported by all. The enduring effects of the COVID-19 pandemic necessitate heightened, tailored care for vulnerable transplant populations. By documenting patients’ actions and experiences, this study supports informed reflection and preparation by transplant professionals, contributing to safer and more responsive care in future crises.

Qualitative exploratory design with a small, single-center sample limits generalizability. The study documents experiences rather than testing interventions and is not intended to provide directly applicable solutions or evidence for practice. Intentional sampling across postoperative times may introduce selection considerations.