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

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.

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.

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.

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.