BACKGROUND
Employment is an important metric of post-transplant functional status and the quality
of life yet remains poorly described after heart transplant. We sought to characterize
the prevalence of employment following heart transplantation and identify patients
at risk for post-transplant unemployment.
METHODS
Adults undergoing single-organ heart transplantation (2007-2016) were evaluated using
the UNOS database. Univariable analysis was performed after stratifying by employment
status at 1-year post-transplant. Fine-Gray competing risk regression was used for
risk adjustment. Cox regression evaluated employment status at 1 year with mortality.
RESULTS
Of 10,132 heart transplant recipients who survived to 1 year and had follow-up, 22.0%
were employed 1-year post-transplant. Employment rate of survivors increased to 32.9%
by year 2. Employed individuals were more likely white (70.8% vs 60.4%, p < 0.01), male (79.6% vs 70.7% p < 0.01), held a job at listing/transplant (37.6% vs 7.6%, p < 0.01), and had private insurance (79.1% vs 49.5%, p < 0.01). Several characteristics were independently associated with employment including
age, employment status at time of listing or transplant, race and ethnicity, gender,
insurance status, education, and postoperative complications. Of 1,657 (14.0%) patients
employed pretransplant, 58% were working at 1-year. Employment at 1year was independently
associated with mortality with employed individuals having a 26% decreased risk of
mortality.
CONCLUSION
Over 20% of heart transplant patients were employed at 1 year and over 30% at 2 years,
while 58% of those working pretransplant had returned to work by 1-year. While the
major predictor of post-transplant employment is preoperative employment status, our
study highlights the impact of social determinants of health.
KEYWORDS
Abbreviations:
SF-36 (36-Item Short Form Survey), UNOS (United Network for Organ Sharing), STAR (Standard Transplant Analysis and Research), CKD (Chronic Kidney Disease), OPTN (Organ Procurement and Transplantation Network)To read this article in full you will need to make a payment
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Publication history
Published online: January 05, 2023
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