*Purpose: Trends in liver transplant (LT) have shifted, and increasingly, individuals with alcohol liver disease (ALD) are receiving LT without 6-months of sobriety (Lee & Terrault, 2018). Although some research suggests the 6-month rule may not be a significant predictor of survival and sobriety outcomes (Mathurin et al., 2011), the potential misinterpretation of this finding poses significant risks for transplant candidates, recipients, and centers. Because individuals with ALD and less than 6-months of sobriety are at high risk for alcohol relapse post-transplant, which may lead to graft failure and patient death (Rice et al., 2013), it becomes increasingly important to appropriately consider the various psychosocial factors known to influence sobriety in selecting transplant candidates with ALD (Rodrigue, Hanto, & Curry, 2013). Currently, variability and lack of clarity regarding revised selection criteria for individuals with ALD seeking early LT across transplant centers in conjunction with competition between programs, which likely relaxes acceptance criteria (Asrani et al., 2020), potentially compromises the fair allocation of organs.

*Methods: This study explored psychosocial factors associated with ALD, LT, and alcohol relapse to inform the development of objective revised practices that minimize the risk for increasing disparity among subgroups receiving LT. Specifically, we retrospectively reviewed medical records of all adults referred for liver transplant evaluation (n = 326) from January 2019 through December 2019 at a large diverse transplant center in the southeast to identify trends in the existing evaluation and selection processes and short-term outcomes.

*Results: Overall, data suggest that the evaluation process and selection criteria varied among individuals referred for transplant. Within the listed population (n = 107) preliminary results show a significant correlation between age, race, education level, ALD and receiving LT. Among those transplanted (n= 59), 54% of recipients had primary UNOS diagnoses of ALD at listing, and there was a significant correlation between receiving LT and gender. Finally, the post-transplant urine drug monitoring data for individuals with ALD is inconsistent.

*Conclusions: Additional analyses will explore psychosocial predictors of LT, but initial results support the need for revised selection criteria to minimize disparity in organ allocation.

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