Research of socioeconomic level and the other factors effecting patient and graft survival on patients undergoing liver transplantation

Aim: Liver transplantation, which is the rescue treatment for chronic and irreversible liver diseases, is ever increasingly applied owing to the developments in surgical techniques and the availability of various immunosuppressive drugs. There are 21878 registered patients in the organ waiting list of the ministry of health and 1851 of them are waiting for liver transplantation. Unfortunately this increasing demand is still met by living donors. The severity of this fact comes into view when noticing that each year, the 8-10 % of the patients waiting for organ transplant lose their life. Because of the existing limited potentiality, appropriate patient selection, transplant timing and post-op follow-up are all substantially important regarding the patient and graft survival. There are many factors affecting the patient and graft survival. Factors such as the features of the donor, the operation related specifics, the complications after the transplant, the immunosuppressive drugs used, the features of the receiver and the patient compliance are definitely of primary significance. The receiver features like socioeconomical and educational level are the primary factors effective on patient compliance. Our research is aimed to observe the impacts of patient's socioeconomical and educational level, as well as all the other before mentioned factors on patient and graft survival. Material and Method: All the patients that underwent successive liver transplantation between 2006 and 2011 in Dokuz Eylul University Medical Faculty General Surgery Department, aged over 18 years, and had accessible data were involved in this research. Patient and donor data were gathered from the data obtained during patient diagnosis, treatment and follow-up, the computer automation system used in the hospital, the hospital archive files, the liver transplant unit's patient follow-up files, the liver polyclinic's patient follow-up forms and the telephone interviews. Results: In our research patient compliance was evaluated for 278 patients and 68.3 % were found to be noncompliant. Patient compliance was not found to be significantly effective on patient and graft survival. But the lowness in the parameters like educational level, occupational level and socioeconomical level were determined to be related to the patient compliance. 72.4 % of our patients had low educational level, 75.8 % of them had low occupational level and 77.6 % of them had low socioeconomical level. But these factors were not found to be significantly related to patient and graft survival. Discussion: As a result socioeconomical level did not demonstrate a direct affect on patient and graft survival. On the other hand, apart from patient and graft survival, the occupational state and educational level which determine the socioeconomical level were significantly related to the parameters such as liver failure aetiologies, comorbid diseases, alcohol usage histories, the developmental status of the place of birth and living, social assurance states, drug and visit noncompliances which have an affect on the success of liver transplant. Consequently, during the follow-ups before the transplant, the educational and occupational level of the patient should be taken into consideration. Therefore by taking these factors into account during the follow-up and selection of patients, and by carrying out studies with more patients and with extended follow-up durations, their affects on patient and graft survival can be shown. Keywords: Liver transplantation, socioeconomical level, patient compliance, patient survival, graft survival