Impact of Academic Background on Early Hospital Readmission and Graft Survival After Liver Transplantation: A Single‐Center Experience in Ohio

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Abstract
Introduction: Most studies on socioeconomic factors in liver transplantation (LT) rely on national databases without considering regional characteristics. This study uniquely investigated how educational attainment, income, and insurance status simultaneously impact early readmission and graft survival among LT recipients at a single center in Ohio, accounting for county‐level characteristics. Methods: This retrospective observational cohort study included 782 adult primary orthotopic LT recipients at Ohio State University Wexner Medical Center (2016–2023). Educational attainment was stratified into high, intermediate, and low levels. Income was estimated from county‐level census data. Insurance status was categorized as private or public. Graft survival (GS) and 30‐day readmission were analyzed using Kaplan–Meier methodology and multivariate regression. Results: Higher education correlated with higher income ( p < 0.001) and lower BMI ( p = 0.04). Three‐year GS rates were 92.7%, 88.6%, and 86.0% for high, intermediate, and low educational groups, respectively (high vs. low, p = 0.01). Private insurance showed superior GS compared to public insurance (90.2% vs. 83.5%, p = 0.02). Multivariate analysis identified low education (HR: 1.61, 95% CI: 1.01–2.59, p = 0.047 with high educational level as reference) as an independent risk factor for graft failure. The high educational group had significantly lower 30‐day readmission rates compared to the intermediate group (27.4% vs. 37.0%, p = 0.047). Conclusion: By focusing exclusively on Ohio's population and comprehensively analyzing multiple socioeconomic factors simultaneously, this study demonstrates that educational attainment independently influences post‐LT outcomes. Patients with lower educational backgrounds may benefit from enhanced post‐discharge education and more intensive follow‐up.

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