Work Ability and Labor Supply after Kidney Transplantation

Abstract

Background: The vocational rehabilitation after kidney transplantation (KTX) is suboptimal. We sought to evaluate correlates of occupational outcomes after KTX. Methods: We included 336 working-age patients with at least one creatinine assessment in the 3-month screening period. We collected clinical information from medical records. All subjects answered a self-administered questionnaire, and a follow-up questionnaire was mailed to each participant after 6 months. Study outcomes were the Work Ability Index (WAI) and labor supply (the number of days each patient worked in the follow-up period). We estimated the glomerular filtration rate (eGFR) with the Modification of Diet in Renal Disease Study equation. Results: The mean eGFR was 52.76 ± 23.68 ml/min/1.73 m². The age-standardized employment-to-population ratio was 62%. Comorbidities, self-reported work ability, gender, age, health insurance type, and time since transplant were associated with employment status at baseline. The WAI (38.79 ± 5.88) was associated with the severity of renal impairment, work attachment and comorbidities. After 6 months, labor supply (mean 19.4 ± 9.7 weeks) was associated with WAI item 1 (ρ = 0.22; p = 0.03); eGFR was significantly associated with labor supply, and this association was slightly stronger in patients with physically demanding jobs. Conclusions: We identified modifiable factors associated with poor occupational outcomes in kidney transplant recipients. Consistent with labor supply theory, our results suggest that health care coverage plays a key role in employment decisions after KTX independent of possible confounders. Additionally, our study provides the rationale to further evaluate the implications of renal function-preserving strategies for indirect cost savings and self-reported ability to work after transplant.

Employment 12 months after kidney transplantation: An in-depth bio-psycho-social analysis of the Swiss Transplant Cohort

“…Additionally, a high SPH 6 month post-Tx predicted being employed 12 months post-Tx. This is in line with Sangalli et al [11] who showed in a follow-up study post-Tx that good physical health perception enhances the chances of being employed.…”

“…In agreement with most return to work studies taking pre-Tx employment status into account [4–7, 9–11], pre-Tx employment was the strongest predictor for post-Tx employment. 81% of the patients who were employed pre-Tx were employed 12 month post-Tx, versus 18% of those who were not employed pre-Tx.…”

“…Comparable results were found in reports from the US [11] and from Belgium [22] with 56% and 58% employed post-Tx, respectively. Compared to other studies, the post-Tx employment rate is high [14, 16, 17, 23, 24].…”

“…The SPH values of the group working 12 months post-Tx (mean 80.4) are similar to those of 800 town employees in Switzerland aged 45–65 years (mean 79.1) [44]. Also others showed that those employed post-Tx have a better quality of life especially in the physical domain [11, 28, 38]. Additionally, a high SPH 6 month post-Tx predicted being employed 12 months post-Tx.…”

“…Over the past years, several predictors of not being employed post-Tx in kidney patients have been identified: Post-Tx employment status was consistently and highly correlated with pre-Tx employment status [4–7, 9–11]. Receiving a kidney from a living donor was regularly found to enhance social participation [12] and to specifically enhance the chance to be employed [6, 9, 13, 14].…”