Aim Interventions to prevent excessive weight gain after liver transplant are needed. The purpose of the present study was to enhance a specialist post‐transplant well‐being program through knowledge exchange with end‐users. Methods The study used an interactive process of knowledge exchange between researchers, clinicians and health system users. Data were collected as focus groups or telephone interviews and underwent applied thematic analysis. Results There were 28 participants (age 24–68 years; 64% male). The results identified experiences that may influence decisions around health behaviours during the course of transplant recovery. Three over‐arching themes were identified that impact on liver transplant recipients post‐transplant health behaviours. These include (i) Finding a coping mechanism which highlighted the need to acknowledge the significant emotional burden of transplant prior to addressing long‐term physical wellness; (ii) Back to Life encompassing the desire to return to employment and prioritise family, while co‐ordinating the burden of ongoing medical monitoring and self‐management and (iii) Tailored, Personalised Care with a preference for health care delivery by transplant specialists via a range of flexible eHealth modalities. Conclusions This person‐centred process of knowledge exchange incorporated experiences of recipients into service design and identified life priorities most likely to influence health behaviours post‐transplant. Patient co‐creation of services has the potential to improve the integration of knowledge into health systems and future directions will require evaluation of effectiveness and sustainability of patient‐centred multidisciplinary service development.

Weight gain occurs early post-transplant, with significant metabolic dysfunction present within 6 months, however is not associated with significant psychological distress. Early dietary intervention designed to limit weight gain and target cardiometabolic health is recommended for this unique patient population.

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Aim: To describe current practice and priorities of dietitians during the acute (≤3 months) and long-term (≥6 months) management of liver transplant recipients. Methods: Ten liver transplant dietitians (10/14, 71%) in Australia, New Zealand, UK and USA responded to an online survey. The survey graded nutrition priorities on a Likert scale, recorded barriers to service delivery and workforce allocation for nutrition services (ratio of full-time equivalent: annual transplant rate). Results: Just over half (n = 6, 60%) reported routine dietary assessment post-liver transplant. The majority (90%, n = 9) also provide initial dietary education in the acute setting. Thirty percent (n = 3) routinely provide ongoing acute follow up; however, no sites provide routine follow up after 6 months. Dietitian-to-transplant patient ratios demonstrated a broad range of resource allocation across sites 1:244 (1:39-1:1410). 70% (n = 7) reported lack of funding as a major barrier. Protein and energy requirements (n = 10, 100%) were identified as the main clinical focus in the acute period. Prevention of post-transplant weight gain and diabetes were identified as priority areas during the acute period by 60% of respondents (n = 6) and long-term management by all respondents (n = 10, 100%). Conclusion: This international survey identified inconsistent resourcing of nutrition services post-liver transplantation, with lack of funding the main barrier to providing long-term care. While the majority of liver transplant dietitians prioritise prevention of excessive weight gain, long-term follow up is limited. Further research is needed to investigate the optimal management of liver transplant recipients.

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