title: Impact of recipients' socio-economic status on patient and graft survival after liver transplantation: the IsMeTT experience.
abstract: OBJECTIVE
  We aimed to determine whether education level and socioeconomic status in a cohort of liver transplant recipients in the south of Italy were potential predictors of graft and patient survival.
  
  
  METHODS
  This retrospective study included 221 liver transplant recipients at Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione between January 2006 and September 2009. Donor gender and age, cold ischaemic time, extended criteria donors, recipient age, gender, body mass index, primary aetiology, Model for End-Stage Liver Disease score, co-morbidities, patient health score assessed on the basis of clinical follow-up, highest level of education achieved, and socioeconomic status were collected and analysed.
  
  
  RESULTS
  Kaplan-Meier analysis of survival measured by education level and socioeconomic status showed a higher survival rate in patients with higher education level (p=0.04) and socioeconomic status (p=0.01). After adjusting for all covariables, results of the multivariate Cox regression analyses showed that only socioeconomic status remained an independent and significant predictor of overall survival (Hazard Ratio=0.16, p=0.03).
  
  
  CONCLUSIONS
  Patient survival after liver transplantation was influenced by low income, low educational level, and lack of access to quality health care. Prospective clinical studies are necessary to fully identify the impact of socioeconomic status on long-term health outcomes, and to propose an evidence-based guide to clinical intervention.
authors.affiliation: Is.Me.T.T. (Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), University of Pittsburgh Medical Center, Palermo, Italy. sgruttadauria@ismett.edu
authors.forename: Salvatore
authors.initials: S
authors.lastname: Gruttadauria
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Grosso
authors.forename: Antonio
authors.initials: A
authors.lastname: Mistretta
authors.forename: Duilio
authors.initials: D
authors.lastname: Pagano
authors.forename: Giovanni
authors.initials: G
authors.lastname: Scianna
authors.forename: Giovan Battista
authors.initials: GB
authors.lastname: Vizzini
authors.forename: Davide
authors.initials: D
authors.lastname: Cintorino
authors.forename: Marco
authors.initials: M
authors.lastname: Spada
authors.forename: Francesco
authors.initials: F
authors.lastname: Basile
authors.forename: Bruno
authors.initials: B
authors.lastname: Gridelli
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D004522:Educational Status; D005260:Female; D006085:Graft Survival; D006801:Humans; D007558:Italy; D053208:Kaplan-Meier Estimate; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012959:Socioeconomic Factors