Post-Transplant Employment and Its Relationship to Physical Status in Kidney Transplant Recipients

Abstract

Post-transplant employment has long been considered an indication of functional benefit to the recipient and social benefit to the community. Some studies suggest that the majority of transplant recipients are physically able but remain unemployed and continue to draw disability post-transplant. In this article, the employment status and perception of 110 kidney transplant recipients from a specialty kidney transplant clinic that follows recipients from three hospital programs were compared by use of The American Medical Association’s Guide to Physical Impairment (AMAGPI) and creatinine clearance. Overall, there was approximately the same number of males and females (54% vs 46%, respectively), in middle adulthood (mean = 43 years), well-educated (mean = 14 years of schooling), Caucasian (55%) and married (57%). Of those surveyed, 77% (n = 85/110) were classified as employed and 23% (n = 25/110) were disabled. After excluding those who were disabled and using AMAGPI criteria as the basis for comparison, it was found that 80% (n = 68/85) with kidney impairment ranging from 0% to 14% were employed compared with 64% (n = 16/25) for all other impairment classifications combined. When broken down by AMAGPI groups, no significant differences were found between mean creatinine clearances with regard to employment status and employment perception.
When employment status and patient employment perception are compared by traditional means (i.e., creatinine clearance), there is only minimal change in employment rates observed even as the lab values continue to decline and impairment level increases. Thus, use of criteria accounting for issues specifically related to kidney recipients (e.g., medication reactions, chronic pain) suggest that, unlike other solid organ transplantation, the reason for unemployment and continued perception of inability to work remains a complex phenomenon and is not directly related to organ functioning or physical impairment. These findings clearly conflict with earlier reports and indicate the need for additional study to help determine whether other physical limitations specific to the patient’s continued perception of inability to work in the kidney transplant population exist or strategic rehabilitation interventions and case management (such as a structured rehabilitation program specific to outcomes) could improve employment results.