Predictors of long-term employment among patients with cystic fibrosis undergoing lung transplantation
AIMS OF THE STUDY
Lung transplantation is an established therapy in selected patients with advanced cystic fibrosis lung disease. Resumption of employment after lung transplantation is generally supported. In Switzerland, there are no data on long-term employment in people with cystic fibrosis undergoing lung transplantation.
In a single-centre, cross-sectional study at a Swiss university hospital, clinical data from lung transplant recipients with cystic fibrosis, covering the transplantation period from January 1996 to December 2016, were analysed retrospectively. The potential influence of pre-lung transplantation factors (age, sex, lung function, body mass index, six-minute walk test distance, lung transplantation wait list time, paid employment on the wait list, education, relationship status, housing situation) and post-lung transplantation factors (chronic allograft dysfunction [CLAD], dialysis, cancer diagnosis [except skin cancer]) on paid employment and work percentage after lung transplantation were investigated using mixed logistic and linear regression models. Descriptive analyses of paid employment were performed for various periods after lung transplantation (<1, 1–3, 3–5, 5–10, >10 years). Data are reported as odds ratios (ORs) or coefficients (β) with their 95% confidence intervals (CIs).
Eighty-four subjects (46.4% female) with a mean ± SD age of 29.9 ± 8.4 years were included in the study. Mean wait time for lung transplantation was 42.7 ± 40.2 weeks. The number (percentage) of subjects employed <1 year, 1–3 years, 3–5 years, 5–10 years and >10 years after lung transplantation was n = 23 (28%), n = 51 (65%), n = 44 (75%), n = 30 (68%) and n = 21 (75%), respectively. In mixed logistic regression models, pre-lung transplantation paid employment (OR 24.03, 95% CI 6.08 to 164.39, p <0.0001), academic education (OR 7.81, 95% CI 1.66 to 48.66, p = 0.01) and time post lung transplantation (on log scale, OR 5.81, 95% CI 3.15 to 12.78, p <0.0001) were the main factors influencing post-lung transplantation paid employment status. In mixed linear regression models, pre-lung transplantation paid employment (β = 21.40, 95% CI 10.98 to 31.81, p = 0.00014), academic education (β = 12.54, 95% CI 0.48 to 24.55, p = 0.05) and time post lung transplantation (on log scale, β = 8.96, 95% CI 6.17 to 11.82, p <0.0001) were the main factors influencing work percentage post lung transplantation. No evidence for an influence of clinical factors such as CLAD, cancer or dialysis on post-lung transplantation employment and work percentage was found.
Pre-transplant employment is the dominant factor influencing lung transplantation employment in people with cystic fibrosis. People with cystic fibrosis undergoing lung transplantation should be encouraged to work for as long as their health status permits. Professional reintegration after successful lung transplantation should be supported by a multi-disciplinary lung transplant team.
- Farrell PM. The prevalence of cystic fibrosis in the European Union. J Cyst Fibros. 2008;7(5):450–3. doi:.https://doi.org/10.1016/j.jcf.2008.03.007
- MacKenzie T, Gifford AH, Sabadosa KA, Quinton HB, Knapp EA, Goss CH, et al. Longevity of patients with cystic fibrosis in 2000 to 2010 and beyond: survival analysis of the Cystic Fibrosis Foundation patient registry. Ann Intern Med. 2014;161(4):233–41. doi:.https://doi.org/10.7326/M13-0636
- Burgel PR, Bellis G, Olesen HV, Viviani L, Zolin A, Blasi F, et al.; ERS/ECFS Task Force on Provision of Care for Adults with Cystic Fibrosis in Europe. Future trends in cystic fibrosis demography in 34 European countries. Eur Respir J. 2015;46(1):133–41. doi:.https://doi.org/10.1183/09031936.00196314
- Martin C, Hamard C, Kanaan R, Boussaud V, Grenet D, Abély M, et al. Causes of death in French cystic fibrosis patients: The need for improvement in transplantation referral strategies! J Cyst Fibros. 2016;15(2):204–12. doi:.https://doi.org/10.1016/j.jcf.2015.09.002
- Chambers DC, Yusen RD, Cherikh WS, Goldfarb SB, Kucheryavaya AY, Khusch K, et al.; International Society for Heart and Lung Transplantation. The Registry of the International Society for Heart and Lung Transplantation: Thirty-fourth Adult Lung And Heart-Lung Transplantation Report-2017; Focus Theme: Allograft ischemic time. J Heart Lung Transplant. 2017;36(10):1047–59. doi:.https://doi.org/10.1016/j.healun.2017.07.016
- Aberg F, Rissanen AM, Sintonen H, Roine RP, Höckerstedt K, Isoniemi H. Health-related quality of life and employment status of liver transplant patients. Liver Transpl. 2009;15(1):64–72. doi:.https://doi.org/10.1002/lt.21651
- Kousoulas L, Neipp M, Barg-Hock H, Jackobs S, Strassburg CP, Klempnauer J, et al. Health-related quality of life in adult transplant recipients more than 15 years after orthotopic liver transplantation. Transpl Int. 2008;21(11):1052–8. doi:.https://doi.org/10.1111/j.1432-2277.2008.00733.x
- Suhling H, Knuth C, Haverich A, Lingner H, Welte T, Gottlieb J. Employment after lung transplantation--a single-center cross-sectional study. Dtsch Arztebl Int. 2015;112(13):213–9.
- Huda A, Newcomer R, Harrington C, Keeffe EB, Esquivel CO. Employment after liver transplantation: a review. Transplant Proc. 2015;47(2):233–9. doi:.https://doi.org/10.1016/j.transproceed.2014.10.022
- Hunt CM, Tart JS, Dowdy E, Bute BP, Williams DM, Clavien PA. Effect of orthotopic liver transplantation on employment and health status. Liver Transpl Surg. 1996;2(2):148–53. doi:.https://doi.org/10.1002/lt.500020211
- Krivchenia K, Hayes D, Jr, Tobias JD, Tumin D. Long-term work participation among cystic fibrosis patients undergoing lung transplantation. J Cyst Fibros. 2016;15(6):846–9. doi:.https://doi.org/10.1016/j.jcf.2016.07.007
- Vieux L, Simcox AA, Mediouni Z, Wild P, Koller M, Studer RK, et al.; Swiss Transplant Cohort Study. Predictors of Return to Work 12 Months After Solid Organ Transplantation: Results from the Swiss Transplant Cohort Study. J Occup Rehabil. 2019;29(2):462–71. doi:.https://doi.org/10.1007/s10926-018-9804-8
- Paris W, Diercks M, Bright J, Zamora M, Kesten S, Scavuzzo M, et al. Return to work after lung transplantation. J Heart Lung Transplant. 1998;17(4):430–6.
- De Baere C, Delva D, Kloeck A, Remans K, Vanrenterghem Y, Verleden G, et al. Return to work and social participation: does type of organ transplantation matter? Transplantation. 2010;89(8):1009–15. doi:.https://doi.org/10.1097/TP.0b013e3181ce77e5
- Ochman M, Latos M, Orzeł G, Pałka P, Urlik M, Nęcki M, et al. Employment after lung transplantation in Poland - a single center study. Int J Occup Med Environ Health. 2019;32(3):379–86. doi:.https://doi.org/10.13075/ijomeh.1896.01362
- Cicutto L, Braidy C, Moloney S, Hutcheon M, Holness DL, Downey GP. Factors affecting attainment of paid employment after lung transplantation. J Heart Lung Transplant. 2004;23(4):481–6. doi:.https://doi.org/10.1016/S1053-2498(03)00226-2
- Danuser B, Simcox A, Studer R, Koller M, Wild P ; Psychosocial Interest Group, Swiss Transplant Cohort Study. Employment 12 months after kidney transplantation: An in-depth bio-psycho-social analysis of the Swiss Transplant Cohort. PLoS One. 2017;12(4):e0175161. doi:.https://doi.org/10.1371/journal.pone.0175161
- Lian R, Cavalheri V, Wood J, Jenkins S, Straker LM, Hill K. Higher Levels of Education Are Associated With Full-Time Work in Adults With Cystic Fibrosis. Respir Care. 2019;64(9):1116–22. doi:.https://doi.org/10.4187/respcare.06607
- Laborde-Castérot H, Donnay C, Chapron J, Burgel P-R, Kanaan R, Honoré I, et al. Employment and work disability in adults with cystic fibrosis. J Cyst Fibros. 2012;11(2):137–43. doi:.https://doi.org/10.1016/j.jcf.2011.10.008
- Weill D, Benden C, Corris PA, Dark JH, Davis RD, Keshavjee S, et al. A consensus document for the selection of lung transplant candidates: 2014--an update from the Pulmonary Transplantation Council of the International Society for Heart and Lung Transplantation. J Heart Lung Transplant. 2015;34(1):1–15. doi:.https://doi.org/10.1016/j.healun.2014.06.014
- Murer C, Huber LC, Kurowski T, Hirt A, Robinson CA, Bürgi U, et al. First experience in Switzerland in Phe508del homozygous cystic fibrosis patients with end-stage pulmonary disease enrolled in a lumacaftor-ivacaftor therapy trial - preliminary results. Swiss Med Wkly. 2018;148:w14593.