Social determinants of health are associated with liver transplant evaluation and listing in a safety-net referral cohort.

Among safety-net hospital (SNH) patients, little is known about the care cascade to liver transplantation (LT) and the clinical and psychosocial factors that impact evaluation and listing. We obtained clinical and psychosocial data on all patients referred for LT at our SNH from 2016 to 2020. Univariate and multivariate Cox regression were performed to determine factors associated with evaluation and listing for LT. A total of 472 safety-net patients were referred. Seventy-six percent completed an evaluation, out of which 58% were listed. In adjusted models, metabolic-associated steatotic liver disease versus alcohol-associated liver disease as etiology increased odds of evaluation (OR: 6.89, 95% CI: 2.17-21.89) while lack of stable housing (0.30, 0.13-0.71) and <6 months of abstinence (0.22, 0.10-0.46) reduced odds of evaluation. Living in a house rather than rental (2.05, 1.19-3.52); having ample versus limited or no social support (7.86, 3.93-15.73); and having a MELD >25 (vs. ≤25) (3.71, 1.44-9.51) were associated with increased odds of listing while history of polysubstance abuse reduced odds of listing (0.40, 0.19-0.83). A sensitivity analysis including an existing multicenter cohort re-demonstrated the significance of residence, adequacy of social support, and MELD score in the probability of listing. Social determinants of health were key to successful evaluation and listing for LT among referred SNH patients and provided targets for intervention.