Dmitry Tumin1,2, Stephen E Kirkby3,4,5, Joseph D Tobias6,7, Don Hayes3,4,8,5. 1. Department of Pediatrics, Nationwide Children's Hospital, College of Medicine, The Ohio State University, 700 Children's Drive, Columbus, OH, 43205, USA. Dmitry.Tumin@nationwidechildrens.org. 2. Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA. Dmitry.Tumin@nationwidechildrens.org. 3. Department of Pediatrics, Nationwide Children's Hospital, College of Medicine, The Ohio State University, 700 Children's Drive, Columbus, OH, 43205, USA. 4. Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA. 5. Section of Pulmonary Medicine, Nationwide Children's Hospital, Columbus, OH, USA. 6. Department of Anesthesiology, College of Medicine, The Ohio State University, Columbus, OH, USA. 7. Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA. 8. Department of Surgery, College of Medicine, The Ohio State University, Columbus, OH, USA.
Abstract
BACKGROUND: Returning to work is a desirable outcome of lung transplantation that is selective on attained functional status. Survival implications of post-transplant employment are unclear. METHODS: The United Network for Organ Sharing registry was queried for first-time lung transplants performed from May 2005 to March 2015 in patients ages 18-64. Attainment of normal functional status post-transplant, defined as a 100 % score on the Karnofsky Performance Scale (KPS), was examined as moderating 5-year survival outcomes of work resumption, using Cox proportional hazards models. Supplemental analysis examined attainment of forced expiratory volume in 1 s (FEV1) ≥80 % predicted as moderating survival implications of post-transplant employment. RESULTS: Of 10,066 patients, 1824 (18 %) returned to work, while 9078 contributed follow-up data on functional status. Multivariable analysis demonstrated a protective effect of work resumption among patients who did not attain normal functional status before returning to work (HR = 0.62; 95 % CI = 0.51, 0.76; p < 0.001). This association was attenuated among transplant recipients who reached 100 % KPS while still unemployed (p < 0.001). Similarly, post-transplant survival was favorably associated with 5-year survival among patients who did not attain at least 80 % predicted FEV1 before returning to work (HR = 0.71; 95 % CI = 0.59, 0.86; p < 0.001). CONCLUSIONS: Early return to work after lung transplantation may benefit patients experiencing mild functional limitations. Timing the resumption of employment to coincide with attainment of maximal functional status around 1 year post transplant should be considered.
BACKGROUND: Returning to work is a desirable outcome of lung transplantation that is selective on attained functional status. Survival implications of post-transplant employment are unclear. METHODS: The United Network for Organ Sharing registry was queried for first-time lung transplants performed from May 2005 to March 2015 in patients ages 18-64. Attainment of normal functional status post-transplant, defined as a 100 % score on the Karnofsky Performance Scale (KPS), was examined as moderating 5-year survival outcomes of work resumption, using Cox proportional hazards models. Supplemental analysis examined attainment of forced expiratory volume in 1 s (FEV1) ≥80 % predicted as moderating survival implications of post-transplant employment. RESULTS: Of 10,066 patients, 1824 (18 %) returned to work, while 9078 contributed follow-up data on functional status. Multivariable analysis demonstrated a protective effect of work resumption among patients who did not attain normal functional status before returning to work (HR = 0.62; 95 % CI = 0.51, 0.76; p < 0.001). This association was attenuated among transplant recipients who reached 100 % KPS while still unemployed (p < 0.001). Similarly, post-transplant survival was favorably associated with 5-year survival among patients who did not attain at least 80 % predicted FEV1 before returning to work (HR = 0.71; 95 % CI = 0.59, 0.86; p < 0.001). CONCLUSIONS: Early return to work after lung transplantation may benefit patients experiencing mild functional limitations. Timing the resumption of employment to coincide with attainment of maximal functional status around 1 year post transplant should be considered.
Authors: Lisa Cicutto; Carolina Braidy; Sharon Moloney; Michael Hutcheon; D Linn Holness; Gregory P Downey Journal: J Heart Lung Transplant Date: 2004-04 Impact factor: 10.247
Authors: Emily M Rosenberger; Mary Amanda Dew; Andrea F DiMartini; Annette J DeVito Dabbs; Roger D Yusen Journal: Thorac Surg Clin Date: 2012-11 Impact factor: 1.750