*Purpose: Social support requirements in the evaluation of transplant candidates have recently come under increased scrutiny. One criticism is that these requirements delay listing decisions. However, in liver transplant, prior publications neither clearly negate nor support this assertion. Therefore, we performed a retrospective chart review to explore whether recommendations to mobilize social support impact time in evaluation controlling for other patient and psychosocial factors.

*Methods: We performed a retrospective chart review of patients referred for an initial liver transplant evaluation at our center between 1/1/2020-12/31/2021 and extracted information on patient demographics, psychosocial variables and length of evaluation (time to listing decision). Patients presenting in acute liver failure or who expired prior to a listing decision were excluded. Multivariable linear regression was used to identify factors associated with length of evaluation.

*Results: 270 patients were evaluated (Table 1). Multivariate analysis including patient age, gender, race, and years of education demonstrated that psychosocial recommendations overall were associated with increased length of evaluation (p=0.023). However, this was due to recommendations regarding substance abuse (p=0.006) and not mobilization of social support (Table 2). Years of education was marginally associated with decreased evaluation time (p=0.057). Of note, across all patients, only five (1.9%) patients were required to mobilize additional social support with no other psychosocial recommendations of which two (0.07%) were not listed solely due to minimal support criteria with no other contraindication to listing.

*Conclusions: Social support criteria may not negatively delay time to listing decisions in liver transplant candidates when considering other relevant psychosocial and medical criteria. Patients were rarely denied listing (0.07%) solely for lack of social support. Prospective, longitudinal tracking with contextual and objective assessments of social support is needed to clearly differentiate effects.

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