title: The impact of employment status on recipient and renal allograft survival.
abstract: BACKGROUND
  With the improved median survival of kidney transplant recipients, there has been an increased focus on quality of life after transplantation. Employment is a widely recognized component of quality of life. To date, no study has demonstrated a link between post-transplant employment status and recipient and allograft survival after transplant.
  
  
  METHODS
  The records from the United States Renal Data System (USRDS) and the United Network for Organ Sharing (UNOS) from January 1, 1995, through December 31, 2002, were examined in this retrospective study. Two outcomes, allograft survival time (time between the transplantation and allograft failure or censor) and recipient survival time (time between the transplantation and recipient death or censor), were analyzed using Cox models adjusted for potential confounding factors.
  
  
  RESULTS
  Compared to patients working full time at the time of transplantation, those not working by choice have a greater risk to graft [hazard ratio (HR) 1.27, p < 0.001] but not to recipient survival. A similar trend was observed in patients not working at 12 months post-transplant (HR 1.30, p < 0.001 for graft survival but not for recipient survival). However, at five-yr post-transplant not working by choice was protective to the graft (HR 0.47, p < 0.01) as compared to working full time. Results of the analysis in the patient subgroups based on the comorbidities and the overall health status were similar.
  
  
  CONCLUSIONS
  Employment status at the time of transplantation and in post-transplant period has a strong and independent association with the graft and recipient survival. Full time employment at the time of transplant and at one-yr post-transplant is associated with lower risk for graft failure and recipient mortality. However, working beyond the time covered by Medicare might be associated with potential risk for graft survival.
authors.affiliation: Department of Medicine, University of Utah School of Medicine, Salt Lake City, USA.
authors.forename: Emily
authors.initials: E
authors.lastname: Petersen
authors.forename: Bradley C
authors.initials: BC
authors.lastname: Baird
authors.forename: Lev L
authors.initials: LL
authors.lastname: Barenbaum
authors.forename: Alexander
authors.initials: A
authors.lastname: Leviatov
authors.forename: James K
authors.initials: JK
authors.lastname: Koford
authors.forename: Fuad
authors.initials: F
authors.lastname: Shihab
authors.forename: Alexander S
authors.initials: AS
authors.lastname: Goldfarb-Rumyantzev
mesh_terms: D000328:Adult; D004651:Employment; D005260:Female; D006084:Graft Rejection / Q000453:epidemiology* / Q000601:surgery; D006085:Graft Survival; D006801:Humans; D007668:Kidney / Q000601:surgery; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D012189:Retrospective Studies; D015996:Survival Rate; D014184:Transplantation, Homologous