Survivorship Trajectories After Liver Transplantation: Identifying At‐Risk Survivors Needing Intervention

PROJECT SUMMARY Liver transplantation (LT) is the only curative treatment for patients with end-stage liver disease. Despite undergoing a life-saving operation, LT survivors endure complex physical, emotional, and psychological challenges after LT. Predicting who will thrive or languish after LT is challenging. Existing clinical scores have limited predictive value and fail to capture the lived experience of going through this life-changing surgery. This proposal adapts the concept of survivorship from oncology to investigate post-LT recovery and outcomes beyond graft and patient survival. The central hypothesis is that survivorship experiences can be captured best through longitudinal monitoring of patient-reported and clinical characteristics—in turn, this can identify survivorship phenotypes at risk for worse clinical outcomes after LT. Guided by a socioecological model of survivorship, I will: 1) characterize distinct post-LT survivorship phenotypes by mapping trajectories of patient- reported and clinically measured survivorship constructs using group-based trajectory modeling; 2) investigate the relationship between survivorship phenotypes and outcomes including medication non-adherence, quality of life, and health care utilization; 3) adapt a navigator-based intervention into post-LT care and pilot a single- center study exploring the acceptability and feasibility of integrating this navigator intervention into LT care. These data will identify which phenotypes of LT survivors are at risk for worse outcomes and whether a navigator can be integrated into the LT team and successfully direct LT survivors to the necessary resources to overcome challenges. The PI is a clinical researcher and transplant hepatologist at UT Southwestern, with a long-term vision of improving care for LT survivors, including integrating evidence-based interventions to enhance survivorship. The proposed training plan is incorporated with the research aims and builds on her existing knowledge in clinical research whereby she will acquire new, advanced skills in group-based trajectory modeling, longitudinal data analysis, risk prediction, intervention adaptation, and intervention testing. She has assembled an exceptionally talented interdisciplinary team of mentors with complementary expertise: Dr. Amit G. Singal, a world-renowned health services and cancer researcher; Dr. Lisa B. VanWagner, a content expert in LT outcomes including longitudinal data analysis and risk prediction in the LT population; and Dr. Simon Lee, an expert in cancer survivorship and mixed methods. The research studies in this proposal have significant public health impact as they will fill gaps in our understanding of survivorship and clinical care after LT. This award and training plan will provide the PI with the protected time, training, and mentorship, to build an independently funded research career focused on improving survivorship after LT.