JMIR Publications

ABSTRACT

Background:

Liver transplantation has become increasingly common as a last-resort treatment for end-stage liver diseases and liver cancer, with continually improving success rates and long-term survival rates. Nevertheless, liver transplant recipients face lifelong challenges in self-management, including immunosuppressant therapy, lifestyle adjustments, and navigating complex healthcare systems. e-Health technologies hold the potential to aid and optimize self-management outcomes, but their adoption has been slow among this population due to the complexity of post-liver transplant management.

Objective:

This study aims to examine the use of e-Health technologies in supporting self-management for liver transplant recipients and to identify their benefits and challenges to suggest areas for further research.

Methods:

Following the Arksey and O'Malley's methodology of scoping review, we conducted systematic search of five electronic databases: PubMed, the Cumulative Index to Nursing and Allied Health Literature, EMBASE, PsychINFO, and Web of Science. We included studies that (1) examined or implemented e-Health based self-management; (2) included liver transplant recipients aged 18 years or older; (3) were published in a peer-reviewed journal. We excluded studies that (1) were case reports, conference abstracts, editorials, or letters; (2) did not focus on post-transplantation phase; (3) did not focus on self-management; and (4) did not incorporate the concept of e-Health or solely used technology for the purpose of data collection. The quality of the selected e-Health interventions was evaluated using (1) the Template for Intervention Description and Replication guidelines and checklist, and (2) the five core self-management skills identified by Lorig and colleagues.

Results:

Of 1461 articles, 15 studies were included in the final analysis. Our findings indicate that e-Health based self-management strategies for adult liver transplant recipients primarily address lifestyle management, medication adherence, and remote monitoring, highlighting a notable gap in alcohol relapse interventions. The studies employed diverse technologies, including mobile applications, videoconferencing, and telehealth platforms, but showed limited integration of decision-making or resource utilization skills essential for comprehensive self-management. The reviewed studies highlighted the potential of e-Health in enhancing individualized healthcare, but only a few included interactive features, such as two-way communication or tailored goal-setting. While adherence and feasibility were generally high in many interventions, their effectiveness varied due to diverse methodologies and outcome measures.

Conclusions:

This scoping review maps the current literature on e-Health based self-management support for liver transplant recipients, assessing their potential and challenges. Future studies should focus on developing predictive models and personalized e-Health interventions rooted in patient-generated data, incorporating digital human-to-human interactions to effectively address the complex needs of liver transplant recipients. This review emphasizes the need for future e-Health self-management research to address the digital divide, especially with the aging liver transplant recipient population, and to ensure more inclusive studies across diverse ethnicities and regions. Clinical Trial: .