Listed or Left Behind: The Impact of Social Support on Liver Transplant Access

Document Type

Conference Proceeding

Publication Date

8-1-2025

Publication Title

Am J Transplant

Abstract

Purpose: Liver transplantation (LT) is the only curative therapy for patients with decompensated liver disease, but the complex evaluation process for selecting LT recipients limits access for many. “Social support” is a subjective and controversial criterion often used for determining LT eligibility. However, transplant centers inconsistently apply this criterion, and using social support to determine LT eligibility contributes to racial, ethnic, and socioeconomic inequities in transplant listing. Here we investigated the impact of using social support as a criterion for LT listing. Methods: We conducted a retrospective analysis of all patients evaluated for LT between January 1, 2019, and December 31, 2021 at an academic liver center with a clearly defined objective social support evaluation criterion. Logistic regression analysis was used to determine the association between social support inadequacy (unable to report ≥2 support people and/or other significant concerns) and LT listing status. Kaplan-Meier analysis was used to examine the relationship between social support and time-to-decision. Results: Of 711 LT candidates who had social support information available, 498 (70%) were not listed for LT, of whom 13 (2.6%) were not listed for LT solely due to having inadequate social support. After controlling for several variables, having inadequate social support was significantly associated with decreased odds of being listed for LT (odds ratio 0.38; 95% CI, 0.13-0.93). Other predictors of non-listing included female sex and having recommendations for substance use treatment. Conversely, being married/partnered and higher education levels were positively associated with listing. Kaplan-Meier analysis did not show significant differences in time-to-decision based on social support status; however, patients with inadequate social support exhibited a steeper decline in evaluation completion during the initial 125 days. Conclusions: At our transplant center, <3% of patients who were excluded from LT listing were not listed solely due to having inadequate social support, and inadequate social support was significantly associated with a lower likelihood of listing. Social support remains a critical and controversial criterion for determining LT eligibility, and the subjective nature of social support evaluations can perpetuate disparities in access to life-saving transplantation. Standardizing assessments and implementing interventions to strengthen social support systems could reduce inequities and ensure more equitable access to transplantation. CITATION INFORMATION: Toiv A., Yoshida A., Roberman J., Doshi N., Poisson L., Abouljoud M., Moonka D., Jesse M. Listed or Left Behind: The Impact of Social Support on Liver Transplant Access AJT, Volume 25, Issue 8 Supplement 1 DISCLOSURES: A. Toiv: None.

Volume

25

Issue

8

First Page

S493

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