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Objective Composite deprivation scores have proven useful to evaluate the impact of social determinants on healthcare access, yet the lack of a standardised approach limits their widespread utility. As liver transplantation (LT) remains the only curative treatment for end-stage liver disease (ESLD), we systematically reviewed whether lower socioeconomic status (SES), measured using composite deprivation indices, is associated with increased mortality before or after transplantation.Design Systematic review without meta-analysis.Data sources MEDLINE and Embase were searched from database inception to 19 February 2025, with reference-list screening of key papers.Eligibility criteria Observational studies reporting ESLD-related mortality by deprivation groups (defined with SES deprivation indices), candidates referred or registered for deceased-donor LT, or LT recipients. Eligible studies were required to use national registries or equivalently large datasets.Data extraction and synthesis Two reviewers independently screened studies and extracted data. Risk of bias was assessed using an expanded Critical Appraisal Skills Programme framework. Results were synthesised narratively following Synthesis Without Meta-analysis reporting guidance.Results 23 studies were included: 9 examined pre-LT survival, 9 post-LT survival and 5 covered both. All but one study were conducted in the United States of America (USA/US), with most published after 2020. 14 different composite indices were used. 79% (11/14) of pre-LT studies found higher prelisting or waitlist mortality in the most deprived groups. Post-LT studies using broad area indices found no significant associations, while those using smaller area data showed that higher post-transplant mortality was more prevalent in more deprived SES.Conclusions This systematic review suggests that socioeconomic deprivation is associated with higher pretransplant mortality, with post-transplant effects varying by the spatial resolution of the deprivation index used. Incorporating composite indices at the smallest spatial scale into transplant evaluation and non-US health-systems planning may help identify universal inequities and inform targeted public health interventions.