Return to work:
A long-term follow-up study after solid organ transplantation in Switzerland
Background: Return to daily activities is one of the major goals of solid organ transplantation together with improvement of a patient’s life expectancy, quality of life (QOL) and physical functioning. Employment and work ability play a key role in social participation in the productive years of a patient and importantly contribute to a patient’s QOL, mental health and general well-being. Improvement of health status after successful solid organ transplantation, however, does not necessarily translate into improvement of return to work or employment status or lead to a reduction of support by social welfare received prior to transplantation.
State of research: For liver, renal, lung and heart transplant recipients, it has been shown that post-transplant returning to work rates are lower than pre-transplant rates and range between 35% and 50%. Several predictors of unemployment have been identified over the past years in organ recipients including poor health, recurrent rejection episodes, and fear of loss of health insurance or disability benefits. On the other hand, higher education and younger age and being male were found as positive predictors of return to gainful employment after transplantation. Although good post-transplant objective functional health was measured in the vast majority of transplanted patients, unemployed patients perceived their health status as significantly lower than employed patients.
Study aims: We aim to identify barriers and facilitators of return to work in the framework of Swiss Transplant Cohort Study (STCS), which is a prospective multicenter cohort study including all transplanted organ recipients in Switzerland. All transplanting centers (Basel, Bern, Geneva, Lausanne, St. Gallen, and Zürich) support a collaborative network and contribute all their patients to the STCS. The proposed aims relate to all transplanted solid organs, particularly to kidney, liver, lung and heart. All analyses will be stratified by organ and gender. Three main study aims were identified:
1. Identify the determinants of the pre-transplant working status stratified by organ and gender.
2. Longitudinal evolution of working status analysis from pre-transplant over the entire post-transplant period: Identify the predictors – both positive and negative- of working status after transplantation and in particular of a sustained work. Identify typical patterns of return to work and explore their predictors.
3. Analysing the influence of working status on health and health behavior.
Significance of the planned research: Maintaining and regaining work status are important topics in Switzerland and internationally. We have a unique opportunity to study the evolution of the work status (pre-transplant and post-transplant), the predictors of return to work and to identify the typical pattern of return to work. Due to the aging workforce, in most European countries as well as in Switzerland, knowledge of facilitating or delaying factors for return to work is increasingly important in order to develop successful intervention strategies.