Development and Testing of an Integrated Care Coordination Intervention for Alcohol Use Disorder Recovery after Liver Transplantation

PROJECT SUMMARY Rates of alcohol use disorder and alcohol associated liver disease requiring liver transplantation continue to rapidly rise. Return to alcohol use after liver transplant is associated with increased rates of liver transplant failure and mortality, but there is no evidence-based integrated intervention to address alcohol use disorder in liver transplant recipients. The goal of this K23 award application submitted by a liver transplant surgeon is to address a critical gap in knowledge and care for liver transplant recipients with concurrent alcohol use disorder by developing and pilot testing an integrated liver transplant and alcohol recovery program (ILTARP) consisting of an integrated community health worker supporting post-transplant alcohol relapse prevention, outreach, and care coordination. To address this knowledge gap, I propose three research aims. Aim 1 is to co-develop the ILTARP intervention with stakeholder and expert input though an iterative process of evidence gathering and stakeholder panels. Aim 2 will conduct a pilot feasibility study of the newly developed ILTARP intervention testing feasibility, acceptability, and potential effectiveness of ILTARP in the liver transplant clinical setting through a randomized control pilot trial (n=40). Aim 3 will assess barriers and facilitators of the ILTARP intervention through an integrated mixed methods approach to prepare the intervention for a future R01 application for a fully powered multisite Hybrid Type 1 effectiveness-implementation trial. My long-term goal is to be an independently funded researcher developing, testing and implementing interventions in solid organ transplantation integrating care of complex co-occurring health conditions. The research aims directly inform my three training goals: Goal 1 to gain advanced knowledge in alcohol use disorder treatment and addictions research; Goal 2 to acquire skills in intervention development and randomized trials of multi-component interventions; and Goal 3 to develop expertise applying implementation research frameworks and evaluating implementation outcomes through the use of mixed methods. The training plan includes guided reading, mentored research projects, monthly seminars, and selected coursework, planned research manuscripts, and frequent mentor meetings to review progress. The research project, the research environment, and the exceptional multidisciplinary mentorship team (Drs. Bartels, Kelly, Aschbrenner) and consultants (Drs. Cameron, Wakeman, Cheng) are ideally suited to my career development. Overall, this career development award will provide the opportunity for me to acquire the necessary research skills to advance my career goal to become a leading expert in intervention development and implementation research in solid organ transplantation integrating care of complex co-occurring health conditions. This formative work has the potential to result in a paradigm shift in liver transplant centers across the nation by broadly disseminating ILTARP to improve access, equity, and long-term outcomes for the growing number of patients suffering from alcohol use disorder and alcohol associated liver disease.