Introduction/Objectives: Low health literacy is associated with poor self-care in chronic diseases, however, is understudied in liver transplantation (LT). Study objectives were to evaluate associations between literacy, functional status, and likelihood of LT listing, and to evaluate determinants of low literacy.

Methods: This was a prospective cohort study at a single transplant center from October 2014-August 2016 of adults undergoing outpatient LT evaluation. Literacy was measured with a brief, validated scale, the Newest Vital Sign (NVS). The maximum score is 6; scores 0-1 indicate low literacy. Functional status was assessed by: answering questions about 1) shrinking (weight loss ≥4.5kg in the past year), 2) exhaustion, and 3) BMI-adjusted dynamometer measured hand grip strength. Clinical outcomes were assessed from the medical record. Logistic regression was used for multivariable models.

Results: A total of 276 LT candidates underwent literacy assessments. The most common liver disease diagnoses were Hepatitis C:32%, alcoholic liver disease:22%, and hepatocellular carcinoma:18%. The median MELD was 12 [IQR: 9-16]. A total of 36% (n=100) patients had adequate literacy, 26% (n=73) limited literacy, and 37% (n=103) low literacy. In univariable analyses, patients with alcoholic liver disease (29% vs 17%, p=0.01), ascites (49% vs 27%, p<0.001), those reporting physical exhaustion (64% vs 45%, p=0.002), and with low grip strength (48% vs. 22%, p<0.001) were more likely to have low literacy scores. 64% of patients were waitlisted for LT, 36% were ineligible (of those 5% died, 40%-medical contraindications, 11%-psychosocial contraindications). Patients with low literacy were more likely to be LT-ineligible (46% of low literacy ineligible vs. 30% with adequate literacy, p<0.01). In a multivariable model adjusted for demographics, MELD, ascites, BMI, and liver disease etiology, low grip strength (OR 2.0 95%CI:1.12-3.40, p=0.02) and self-reported exhaustion (OR 2.2, 95%CI:1.06-4.41, p=0.035) were independently associated with low literacy.

Conclusions: LT candidates have lower literacy skills compared to adults with chronic disease. Low literacy is associated with functional impairment and transplant ineligibility. Further studies should examine associations between literacy, encephalopathy and self-care as well changes in literacy scores after transplantation.

CITATION INFORMATION: Serper M, Dwinnells K, Wolf M, Olthoff K. Health Literacy, Functional Status and Transplant Eligibility Among Adult Liver Transplant Candidates. Am J Transplant. 2017;17 (suppl 3).

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