*Purpose: Health Literacy (HL) impacts post-transplant outcomes and listing for kidney transplant patients, but little is known about likelihood of solid organ transplant for kidney and other organs based on combined HL of the patient and their caregiver.

*Methods: Patients and caregivers undergoing evaluation for kidney, liver and thoracic (non-kidney) organ transplantation were enrolled from June-Dec 2013 with long-term follow-up through July 2019. HL was determined via the Short Literacy Scale with high HL=15. A pair was defined as high HL if either the patient or the caregiver had high HL. Differences in HL were analyzed using chi-squared tests. The association of patient, caregiver and high pair HL with the likelihood of death or de-listing due to being too ill was evaluated using cumulative incidence competing risk models, with the competing event being deceased donor organ transplant.

*Results: 207 pairs [154 kidney, 53 non-kidney (29 liver, 24 thoracic)]; 414 total participants) of patients (high HL n=58) and caregivers (high HL n=72) were enrolled. In 126 pairs, either the patient or caregiver had high HL. Rates of listing [61% (n=94) kidney, 62.3% (n=33) non-kidney] and transplantation [32.5% (n=50,18 living and 32 deceased donor) kidney; 41.5% (n=22) non-kidney] did not vary by organ type. Patient, caregiver, and pair HL did not vary significantly between organ type. HL did not vary significantly for patients who were listed or not listed for transplant or between kidney recipients receiving living or deceased donor transplant. Caregiver and pair HL was not significantly associated with increased likelihood of death or removal from waitlist due to deteriorated condition for either organ group. However, in non-kidney candidates, high patient HL was associated with significantly decreased likelihood of waitlist mortality (Table).

*Conclusions: Caregivers are required for solid organ transplant recipients. In this analysis, caregiver HL did not significantly impact patient listing or transplantation; however, patient HL was associated with decreased likelihood of waitlist mortality in non-kidney candidates. While this is a small cohort from a single-center, the caregiver data and 6 years of long-term follow-up after transplant evaluation are noteworthy. Many factors can impact receiving a solid organ transplant, but limited HL is an important factor that could be addressed to improve outcomes.

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