*Purpose: Alcohol-associated liver disease (ALD) is the leading indication for liver transplant (LT) and these patients have been shown to have worse outcomes compared to non-ALD candidates. Socio-behavioral determinants of health (i.e. level of education) have been shown to impact outcomes of cirrhotics. The purpose of this study is to describe the association between education and outcomes: 1) waitlist dropout, 2) LT access, and 3) post-LT mortality among ALD candidates.

*Methods: We used national data from SRTR to study first time LT candidates with a primary indication of ALD listed from 01/01/2003-12/31/2017. We used competing risks regression to quantify the association between education less than or equal to high school and waitlist dropout (death or too sick to transplant) and access to LT. We used Cox regression to determine the impact of education level on post-LT mortality.

*Results: Among 23,874 candidates, 52.7% had less than or equal to a high school education (Table). Candidates with less than or equal to a high school education were 13% more likely to dropout (aSHR: 1.071.131.20, p<0.001) and 4% less likely to undergo LT (aSHR: 0.930.961.00, p=0.047) compared to those with greater than a high school education (Table). The cumulative incidence of mortality for LT recipients with less than or equal to a high school education was higher at 1 year (8.9% vs. 7.7%), 3 years (15.9% vs 13.9%), 5 years (21.9% vs. 19.6%) (p=0.007) compared to those with greater than a high school education. This translated to a 12% increased mortality risk (aHR: 1.041.121.20, p=0.002) for LT recipients with less than or equal to a high school education.

*Conclusions: ALD candidates with less than or equal to high school education are associated with worse waitlist and post-LT outcomes. Further studies and resources should be focused on this population.

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