Beyond graft survival: Health literacy is associated with patient-reported health after liver transplantation.

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 posttransplantation health literacy plays a role in patient-reported physical and mental health. We conducted a large-scale cross-sectional analysis using data from the US. All of Us Research Program of adults with documented LT before completing the "Overall Health" survey (n=1042). Health literacy was assessed using the 3-item Brief Health Literacy Screen (BHLS; range: 3-15), and physical and mental health were assessed using Patient-Reported Outcomes Measurement Information System Global Health T-scores. The multivariable linear regression model was adjusted for age, sex at birth, race and ethnicity, and education. Associations were compared with those in adults with cirrhosis without LT (n=5290) and the general All of Us comparator population. Among 747,029 participants, 1042 recipients of LT 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). Patients who underwent LT displayed lower health literacy compared with the general population (mean BHLS 12.8 vs. 13.4), but higher than adults with cirrhosis (12.4; all p <0.001). Each 3-point increase in the BHLS score was associated with a 3.22-point higher Physical Health T-score (95% CI: 2.52-3.92) and a 2.85-point higher Mental Health T-score (95% CI: 2.09-3.60) after adjustment (both p <0.001). The strength of the association did not differ significantly between recipients and either comparator group. Recipients ​​​​of transplant displayed reduced health literacy, and posttransplant 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 posttransplant care.