Predictors of employment after liver transplantation

Abstract

Employment after orthotopic liver transplantation (OLT) indicates recipients' physical/psychosocial adjustment. Our aim was to determine clinical, socioeconomic and health-related quality of life parameters influencing employment after OLT. Questionnaire on demographics, medical conditions, alcohol and drug use before/after OLT, and a validated 12-Item Short Form Health Survey (SF-12) were mailed to 126 adult OLT patients. Stepwise logistic regression was conducted to identify best predictors of post-OLT employment. Among non-retirees, 49% were employed after OLT. The predictors of employment were: employment status, income, disability status before OLT and Model of End Stage Liver Disease score. These variables had prediction rate of 82%. Individuals working during the five yr prior to OLT were likely to return to work (p<0.0001), particularly those who held a job for >6 months prior to OLT (p<0.0001), income>$80 000 before OLT compared with <$30 000 (p=0.036). Patients receiving Social Security Insurance (SSI) payment for >or=6 months prior to OLT, were less likely to work (p=0.0005). Severity/duration of liver dysfunction prior to OLT did not correlate with employment. Sense of physical health was poorer in those employed after OLT than in unemployed (p=0.0003). Socioeconomic factors were the most important predictors of post-OLT employment.

Long-Term Results of Liver Transplantation

“…However, only 26 to 57% of recipients return to work (44,46,47). This wide range may depend on differing definitions of "employed," on use of non-validated instruments, and on disparity in patient population, sample size, and length of follow-up.…”

“…This wide range may depend on differing definitions of "employed," on use of non-validated instruments, and on disparity in patient population, sample size, and length of follow-up. Proposed predictors of post-LT employment include younger age, pretransplant employment and high income, private insurance, absence of pretransplant diabetes, good physical functioning, and higher general health score (45)(46)(47).…”

Quality of Life and Physical Activity after Liver Transplantation. Literature Review.

“…The possibility to return to work after liver transplantation also depends on the type of work previously held (Loinaz et al, 1999;Sahota et al, 2006;Adams et al, 2006). Interestingly, despite the socio-cultural differences that could affect work patterns and perceptions of QOL, these same results were found among transplant recipients in Japan (Kita et al, 1996), Taiwan (Shih et al, 2000), Sweden (Hellgren et al, 1998) and the United States (Bravata et al, 2001).…”

The role of disparities and socioeconomic factors in access to kidney transplantation and its outcome

“…42,45,47 On the other hand, transplant recipients who worked prior to transplantation and have higher pre-transplant incomes and levels of education, as well as those without diabetes and receiving the kidney from the living donor are more likely to return to work. 42,46 It has been reported that solid organ transplant recipients who return to work differ in several aspects from those who do not, including shorter periods of pre-transplant disability and unemployment (age 35-50 years), higher educational level, retention of health insurance, and a professional job. 43 Furthermore, post-transplant employment is associated with better transplant outcome.…”

“…Employment rates after solid organ transplantation have been reported as low as 45-55% [42][43][44][45][46] driven by poor health, acute rejection episodes, and fear of loss of health insurance or disability benefits. 42,45,47 On the other hand, transplant recipients who worked prior to transplantation and have higher pre-transplant incomes and levels of education, as well as those without diabetes and receiving the kidney from the living donor are more likely to return to work.…”