The COVID-19 pandemic presented significant challenges for liver transplant recipients, a population at increased risk of severe SARS-CoV-2 infection due to immunosuppression. Immunosuppressive drugs, necessary for transplant success, compromise the immune system's ability to fight infection, making these patients highly vulnerable to complications and death from COVID-19. This vulnerability is further amplified by the pre-existing chronic liver disease. The pandemic also created ethical and legal dilemmas related to patient care and resource allocation. Multi-professional teams involved in liver transplantation needed to adapt their services to provide adequate support and care, addressing both the medical and psychosocial needs of this vulnerable population. This study aimed to explore the lived experiences of liver transplant recipients during the pandemic, specifically focusing on the challenges they faced and the strategies they employed to manage the risks of SARS-CoV-2 infection. The central research question was: What challenges and strategies were experienced by patients undergoing liver transplantation, given the increased risk of contamination by SARS-CoV-2?

The literature review cites several studies highlighting the increased risk of severe COVID-19 in immunosuppressed individuals, particularly those with chronic diseases such as liver cirrhosis. Studies discussed the impact of COVID-19 on organ transplantation, including the ethical dilemmas faced by healthcare providers. Existing research also emphasized the reorganization of healthcare services to accommodate the needs of patients during the pandemic, including the use of telehealth. The literature review laid the groundwork for understanding the context in which the current study was conducted, providing a framework for interpreting the findings.

This exploratory qualitative study used a descriptive approach. Data was collected from June to September 2022 at a reference center for liver transplantation in southern Brazil. The sample consisted of 23 liver transplant patients (aged 18+) who received transplants between 2011 and 2022 and remained under the care of the institution during the pandemic. Semi-structured interviews were conducted to gather data on patient profiles, transplant characteristics, challenges faced, and strategies adopted to mitigate the risk of SARS-CoV-2 infection. Ethical approval was obtained, and informed consent was secured from all participants. Data analysis involved thematic analysis of the transcribed interviews; challenges and strategies were categorized and calculated as percentages based on the frequency of mention.

The study revealed that the primary challenges faced by liver transplant patients during the pandemic were dependence on others (reported by all participants), isolation, loneliness, and fear. Specific challenges included financial difficulties due to reduced work capacity during isolation, fear of death, and anxiety related to the uncertainty surrounding COVID-19. A significant number of patients (69.5%) reported not contracting SARS-CoV-2, nor did any family members living with them. Most participants (91.3%) had family support during the pandemic and 69.5% received 3-4 doses of the COVID-19 vaccine. The main strategies employed by participants to minimize the risk of infection centered around establishing support networks to assist with basic tasks and adhering strictly to public health guidelines, including social isolation and the use of personal protective equipment. Reorganization of home space to ensure greater isolation for the transplant recipient was another strategy used by some families. The study also highlighted the significant emotional toll of isolation and separation from family members.

The findings align with existing literature demonstrating the considerable emotional and psychological impact of social isolation and the fear of infection on individuals with chronic illnesses. The increased dependence on others for daily tasks, coupled with the isolation imposed by public health measures, created significant stress and anxiety. While participants demonstrated remarkable resilience by developing coping strategies, the study highlights the need for more robust support systems from healthcare professionals to address both physical and mental health needs. The findings underscore the importance of proactive interventions to mitigate the negative psychosocial consequences of public health measures designed to prevent infectious disease transmission. The unique challenges experienced by liver transplant recipients warrant tailored interventions from healthcare teams to enhance their well-being during and after pandemics.

This study provides valuable insights into the lived experiences of liver transplant patients during the COVID-19 pandemic, highlighting the challenges of dependence, isolation, and fear, as well as the resourceful strategies employed by patients and their support networks. The results emphasize the need for enhanced support from the multi-professional healthcare team, tailored interventions to address psychosocial needs, and flexible healthcare access to alleviate the burdens imposed by pandemics. Future research could focus on developing and evaluating interventions specifically designed to support the mental and physical well-being of this vulnerable population during infectious disease outbreaks.

As a qualitative study with a sample drawn from a single transplant center in southern Brazil, the findings may not be generalizable to all liver transplant populations worldwide. The retrospective nature of the data collection may also introduce recall bias. Furthermore, the study focused on patients' self-reported experiences, potentially limiting the scope of the challenges and strategies examined. Future studies could utilize larger, more diverse samples and mixed-methods approaches to strengthen the generalizability and depth of the findings.