A Bumpy Road: Work Integration of People with Cystic Fibrosis after Lung Transplantation

Abstract

Lung transplantation (LTX) is an established therapy in selected patients with advanced cystic fibrosis (CF) lung disease. Resumption of employment after LTX is generally supported. In Switzerland, there is no data on long-term LTX employment in patients with CF. In a single center cross-sectional study at our institution, data from LTX patients with CF from 01/1996 to 12/2016 were retrospectively analyzed. Influence of potential pre-LTX factors (i.e., age, sex, lung function, body mass index, 6-min walk distance, education, relationship status, housing situation, LTX wait list time, gainful employment on the wait list) and post-LTX factors on gainful employment after LTX [chronic allograft dysfunction (CLAD), dialysis, cancer diagnosis (except skin cancer)] were investigated using mixed logistic regression models with random effects. Descriptive analyses of gainful employment were performed for various periods after LTX (i.e., >1, 1-3, 3-5, 5-10, >10 years). 99 patients (35±10 years; 49.5% female) were enrolled. Mean wait time for LTX was 42±39 weeks. Employment for <1 (n=93), 1-3 (n=90), 3-5 (n=68), 5-10 (n=53) and >10 (n=32) years post-LTX was 35%, 68%, 79%, 72% and 78%, respectively. Pre-LTX gainful employment (OR 32.16, 95% CI 9.48 - 177.09, p<0.0001), vocational training (academic vs. non-academic, OR 4.40, 95% CI 1.07 - 20.55, p=0.04) and time to LTX (log scale) OR 4.94, 95% CI 2.95 - 9.38, p<0.0001) were main factors influencing post-LTX earning capacity. Clinical factors, such as CLAD, had no influence on LTX employment. Pre-LTX employment is the dominant factor influencing LTX employment in people with CF. Patients should be encouraged to work for as long as possible, where health permits. Professional reintegration after successful LTX should be supported interdisciplinary by the LTX team.