Abstract
Current liver transplantation (LT) guidelines recognize perceived health-related quality of life as an important outcome of long-term care, yet it remains unclear whether post-transplantation health literacy plays a role in patient-reported physical and mental health. We conducted a large-scale cross-sectional analysis using data from the U.S. All of Us Research Program of adults with documented LT before completing the “Overall Health” survey (n=1,042). Health literacy was assessed with the 3-item Brief Health Literacy Screen (BHLS; range, 3-15), and physical and mental health with PROMIS Global Health T-scores. Multivariable linear regression adjusted for age, sex at birth, race and ethnicity, and education. Associations were compared with those in adults with cirrhosis without LT (n=5,290) and the general All of Us comparator population. Among 747,029 participants, 1,042 LT recipients had evaluable BHLS scores. Marginal health literacy (BHLS ≤12) was present in 372 recipients (35.7%), including 131 (12.6%) with low health literacy (BHLS ≤9). LT patients displayed a lower health literacy compared to the general population (mean BHLS 12.8 vs. 13.4), but higher than adults with cirrhosis (12.4; all
p
p
<0.001). The strength of the association did not differ significantly between recipients and either comparator group. Transplant recipients displayed reduced health literacy, and post-transplant health literacy was strongly associated with better patient-reported physical and mental health. These findings identify health literacy as a modifiable dimension of long-term transplant survivorship and support its assessment in post-transplant care.