Post-Heart Transplant Employment: Rates, Predictors, and Interventions

Abstract

<h3>Purpose</h3> Heart transplantation (HT) extends survival and improves quality of life, permitting patients to regain a more active role in society. The ISHLT reports that approximately 70% of adult HT recipients can engage in their daily activities without limitation, however, overall rates of employment remain less than 40% between three and five-years post-HT. The purpose of this study is to describe rates, predictors, and interventions of employment in HT recipients based on the available literature. <h3>Methods</h3> We conducted a systematic literature search of four electronic databases in May 2021 using a combination of key terms including "organ transplantation", "return to work", "employment", and "social integration." Eligible studies on post-HT social reintegration, specifically employment, were selected by three independent reviewers. <h3>Results</h3> A total of 4,360 title and abstracts were generated. The literature search and reference lists of relevant articles identified twenty-two papers on post-HT employment rates, nineteen papers on predictors of employment post-HT, and two papers on interventions for social reintegration in HT recipients. Employment was defined as paid part-time or full-time work. Post-HT employment rates were highly variable and ranged from 21% to 73% at 1 year post-transplant. The most frequently reported predictors of post-HT employment were younger age at time of HT, pre-HT employment, higher education, and positive self-perception of workability. Successful Interventions in increasing employment rates and social reintegration included both physical and psychosocial rehabilitation programs reported in a case study and cross-sectional study. <h3>Conclusion</h3> Our review of the available literature has demonstrated variability in post-HT employment rates and some patient characteristics associated with post-HT employment. However, only a small number of interventions have specifically targeted the HT population. We proposed an approach to developing an intervention that is patient informed and requires multidisciplinary methods to identify patients at high risk of unemployment post-transplant, is sustainable outside of the transplant centre, and is patient partnered to ensure feasibility and practicality.