Adaptation before and one year after liver transplantation: a longitudinal grounded theory study

INTRODUCTION: Liver transplant recipients undergo emotional, social and existential changes. Adaptation begins before surgery and continues long after discharge. However, no longitudinal grounded theory study has described this process across the transplantation trajectory. This study explored how individuals adapted by addressing their main concerns. METHODS: Twelve adults (mean age 49.3 years, range 25-70) were interviewed pre- and post-transplantation. Data collection and analysis proceeded concurrently using Charmaz's constructivist grounded theory and the constant comparative method. RESULTS: The grounded theory conceptualised adaptation as striving for a life in social belonging. This process was explained through five interrelated categories: Comprehending, Accepting, Adapting, Coping and Balancing. Before transplantation, participants sought to maintain social belonging by preserving continuity in everyday life despite disruption, uncertainty and hope, reflecting existential concerns and conceptualised as optimising a disruptive situation. One year after transplantation, the process shifted from maintaining to reconstructing social belonging by rebuilding stability while managing vulnerability and ongoing uncertainty, reflecting existential concerns related to vulnerability and the future, conceptualised as managing an uncertain presence. Although the categories persisted across time, their meanings evolved throughout the transplantation trajectory. CONCLUSION: Adaptation after liver transplantation involves creating a stable new normality, that accommodates uncertainty, gratitude, vulnerability and hope.