Graft Loss Risk Linked to Employment

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Renal transplant patients not working full time when they get their organ are at elevated risk

 

Renal graft loss is less likely among transplant recipients who are employed full time when they get their kidneys and at one year postoperatively, according to researchers.

 

At five years post-transplant, however, working full time may be associated with an elevated risk of graft loss.

 

Alexander S. Goldfarb-Rumyantzev, MD, PhD, of the division of nephrology at Beth Israel-Deaconess Medical Center in Boston, and his collaborators reviewed records of 105,181 post-kidney transplant patients.

 

Investigators obtained the information from the U.S. Renal Data System and the United Network for Organ Sharing. At the time of transplantation, 41.7% of recipients were working full time, 10.9% were retired, 36.7% were not working because of illness, and 3% were not working by choice, the study showed.

 

Compared with patients who were working full time at the time of transplantation, those not working by choice had a 27% greater risk of graft loss, but their death risk was unaffected, the researchers reported in Clinical Transplantation (2008; published online ahead of print). Retired recipients had a 27% greater risk of graft loss and a 19% greater risk of death.

 

At 12 months post-transplant, recipients not working by choice had a 30% higher risk of graft loss compared with those working full time, but their death risk was unaffected, according to investigators.

 

At five years post-transplant, however, recipients not working by choice had a 53% reduced risk of graft loss compared with subjects working full time; their death risk was unaffected. Unemployed patients who were looking for work had a 3.67 times greater risk of graft loss; their employment status did not impact their death risk.

 

The authors suggest that worse outcome in recipients working full time at five years post-transplant might have to do with termination of Medicare coverage, which might expose recipients who work to greater financial risk as opposed to those who do not work and are eligible for government benefits.

 

The study did not examine the mechanism of the observed associations, but the authors suggested that employment could reflect patients' subjective, psychological, and social well-being. Patients' will and desire to return to active life could lead to better outcomes.

 

"This could be reflected in their medication compliance and overall health maintenance practices,” the researchers wrote.

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