Attained Functional Status Moderates Survival Outcomes of Return to Work After Lung Transplantation.

Abstract

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. 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 1s (FEV1) ≥80% predicted as moderating survival implications of post-transplant employment. 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). 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 1year post transplant should be considered.