*Purpose: Social support and social circumstances (SSSC) are critical yet less described entities in post-orthotopic liver transplant (OLT). We aimed to describe SSSC and correlate the nature of social support with post-OLT outcomes in a predominantly rural post-OLT cohort (Arkansas, US). This study also evaluated whether disparities exist between patients’ social circumstances and nature of primary support (PS).

*Methods: A retrospective cohort study was done on 166 patients who had undergone OLT between January 2014 and September 2019. We attempted to characterize the SSSC of the cohort, which included the nature of PS (spouse vs. non-spouse, number of PS, and if living with PS) and social characteristics (age, gender, ethnicity, employment status, presence of psychiatric diagnosis, drug abuse, and distance of a patient’s residence from the transplant center [DTC]). We also correlated nature of PS with post-OLT outcomes.

*Results: There were 166 patients composed primarily of males (67.3%), mean age of 55.3 ± 10.8 years, and 86.7% Caucasian. The predominant etiology for liver disease was alcohol (32.5%). Majority of patients (58.4%) had more than 2 people for PS. 64.5% had a spouse as PS and 85.5% lived with their PS. The age at transplant (p=0.32), gender (p=0.65), ethnicity (p=0.83), etiology of liver disease (p=0.37), employment status (p=0.83), history of illicit drug use (p=0.83) and a psychiatric diagnosis (p=0.38) did not influence the number of PS. These variables didn’t influence the type of PS and patient living with PS. Mean DTC (± SD) was 89.0 ± 68.6 miles and 41.6% lived more than 100 miles from the transplant center.

The outcomes of OLT analyzed, including post-OLT survival (p=0.81), prolonged hospitalization after transplant (≥ 10 days, p=0.34), 30-day readmission (p=0.83), 1-year readmission (p=0.99), 2-year readmission rates (p=0.87), and rejection at 1 year (p=0.49) and 2 years (p=0.13) did not correlate with number of PS. These outcomes also didn’t correlate with the type of PS or the patient living with the PS. Analysis of DTC trended towards worsened post-OLT outcomes including 30-day readmission (p=0.08), number of hospitalizations in 2 years (p=0.08) and rejection in 2 years (p=0.07), but did not correlate with other outcomes like post-OLT survival (p=0.89), prolonged hospitalization (p=0.44), number of hospitalizations in 1 year (p=0.71) and rejection in 1 year (p=0.34).

*Conclusions: Established SSSC remains imperative when undergoing liver transplantation. Distance from transplant center appears to be a critical component in this, which may correlate with early readmissions after OLT (30 days), increased readmissions (at 2 years) and rejection on long term follow up (2 years). Future studies may evaluate the role of telemedicine visits on improving these outcomes in predominantly rural cohorts.

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