No abstract

Transplant centers conventionally require at least 6 months of alcohol abstinence before offering liver transplants for alcohol-associated liver disease. However, early liver transplant (ELT)—proceeding with a transplant when clinically necessary without first meeting the conventional requirement—is increasingly gaining attention. In our study, we qualitatively assessed ELT recipients’ perceived challenges and supports regarding alcohol-associated liver disease, transplant, and posttransplant survivorship. To diversify perspectives based on gender, race/ethnicity, age, time since ELT, and pretransplant abstinence duration, we purposively recruited ELT recipients and conducted semistructured interviews. Recruitment continued until data saturation. We analyzed transcripts using inductive thematic analysis. We interviewed 20 ELT recipients between June and December 2020 and identified themes within 3 participant-characterized time periods. Three themes emerged in life before severe illness: (1) alcohol as a “constant” part of life, (2) alcohol use negatively affecting relationships and work life, and (3) feeling “stuck” in the cycle of drinking. Two themes emerged during the severe illness period: (4) rapidity of health decline and (5) navigating medical care and the 6-month abstinence requirement. Finally, in life after transplant, 4 themes emerged: (6) feelings of shame or stigma and new self-worth, (7) reconnecting with others and redefining boundaries, (8) transplant as a defining point for sobriety, and (9) work-related challenges. Overall, participants expressed gratitude for receiving a gift of life and acknowledged their responsibilities to the new liver. ELT recipient experiences reveal complex psychosocial challenges related to addiction, inadequate support system, and stigma, particularly in the posttransplant period. The care of ELT recipients would be incomplete if focused solely on optimizing patient or graft survival.

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The latest developments in well construction rely on advanced drilling and completion technologies to withstand increased wellbore deviation, tortuosity, and complex geometry challenges necessary to access reservoirs, which can create challenges to cement placement between reservoir zones. Hence, well integrity and reservoir management concerns can arise given the possibility for multiple reservoirs to communicate, resulting in undesired crossflow and water production because of poor cement isolation. Poor cement placement behind casings, ineffective zonal isolation, and well integrity issues have been traditionally addressed using workover or drilling rigs to remove production tubing and perform either a remedial cement squeeze or zonal abandonment for subsequent sidetrack. However, this generally entails production deferral, capital-intensive rig rates, the potential risks of pulling and running production tubing, which often translates in formation damage from killing the well, large wellsite footprint requirements, and higher logistic demands for rig support equipment. This paper describes the systematic process used to identify, diagnose, design, and execute a successful inter-reservoir crossflow mitigation operation in a naturally fractured carbonate formation in Abu Dhabi using a cost-effective solution with rigless coiled tubing-deployed technologies and a hydrocarbon-based microfine cement slurry that activates upon contact with water. The results enabled the operator to restore reservoir integrity, improve reservoir management, and enhance water sweep. Post-operation reservoir evaluation validated the successful use of the technology for rigless zonal isolation using coiled tubing (CT) for the first time in the United Arab Emirates, providing significant cost benefits and new best practices to reduce the water cut and restore wellbore integrity.