Background: The costs of productivity lost in transplant patients poses a concern, as a significant number of patients are of working age. Furthermore, healthcare and public health literature highlight the relationship between a lack of secure income and poor health outcomes. However, few studies have examined predictors of paid employment post-transplant and the impact of employment status on clinical outcomes.

Objective: (1) To investigate the rates and predictors of post-transplant employment status; (2) to examine the association between post-transplant employment status and clinical outcomes in kidney transplant recipients (KTR).

Methods: A retrospective cohort study was conducted in adult patients undergoing a kidney transplant between 1-Jan-2007 and 31-Dec-2014, with follow up until 31-Dec-2015 at the Toronto General Hospital. Employment status and clinical data were obtained from paper and electronic charts. The Kaplan-Meier product limit method was used to assess time to return to work and time to total graft loss from the transplant date. Multivariable Cox proportional hazards models were fitted to examine independent predictors of post-transplant employment and the association between employment status and total graft loss.

Results: Among the 1069 KTR in the study cohort, the mean age was 50.7 (+ 13.6) and 60.2% were male. A total of 319 KTR returned to work over the first-year post-transplant (cumulative probability 30.4%). Significant independent predictors of employment within the first-year post-transplant included pre-transplant employment status, age at transplant, length of stay in hospital after transplant, physical disability, and private drug coverage. After adjusting for relevant covariates (including comorbid conditions), being employed (vs. not employed) post-transplant was associated with a significantly lower risk of total graft loss (HR 0.29 [95% CI: 0.17, 0.50]).

Conclusions: Although transplantation improves working capacity in end-stage renal disease patients, post-transplant employment status was impacted by other factors, including pre-employment status. These findings support the need for pre- and/or post-transplant interventions to improve participation in paid work following kidney transplantation.

CITATION INFORMATION: Kim J, Rana J, Ashwin M, Li Y, Famure O. Employment Patterns After Kidney Transplantation: Rates, Contributing Factors, and Outcomes. Am J Transplant. 2017;17 (suppl 3).

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