title: Work ability and labor supply after kidney transplantation.
abstract: BACKGROUND
  The vocational rehabilitation after kidney transplantation (KTX) is suboptimal. We sought to evaluate correlates of occupational outcomes after KTX.
  
  
  METHODS
  We included 336 working-age patients with at least one creatinine assessment in the 3-month screening period. We collected clinical information from medical records. All subjects answered a self-administered questionnaire, and a follow-up questionnaire was mailed to each participant after 6 months. Study outcomes were the Work Ability Index (WAI) and labor supply (the number of days each patient worked in the follow-up period). We estimated the glomerular filtration rate (eGFR) with the Modification of Diet in Renal Disease Study equation.
  
  
  RESULTS
  The mean eGFR was 52.76 ± 23.68 ml/min/1.73 m(2). The age-standardized employment-to-population ratio was 62%. Comorbidities, self-reported work ability, gender, age, health insurance type, and time since transplant were associated with employment status at baseline. The WAI (38.79 ± 5.88) was associated with the severity of renal impairment, work attachment and comorbidities. After 6 months, labor supply (mean 19.4 ± 9.7 weeks) was associated with WAI item 1 (ρ = 0.22; p = 0.03); eGFR was significantly associated with labor supply, and this association was slightly stronger in patients with physically demanding jobs.
  
  
  CONCLUSIONS
  We identified modifiable factors associated with poor occupational outcomes in kidney transplant recipients. Consistent with labor supply theory, our results suggest that health care coverage plays a key role in employment decisions after KTX independent of possible confounders. Additionally, our study provides the rationale to further evaluate the implications of renal function-preserving strategies for indirect cost savings and self-reported ability to work after transplant.
authors.affiliation: Dipartimento di Scienze Cliniche e di Comunità, Università di Milano, Milan, Italy.
authors.forename: Valentina
authors.initials: V
authors.lastname: Sangalli
authors.forename: Jonathan
authors.initials: J
authors.lastname: Dukes
authors.forename: Syamsundara Babu
authors.initials: SB
authors.lastname: Doppalapudi
authors.forename: Giovanni
authors.initials: G
authors.lastname: Costa
authors.forename: Luca
authors.initials: L
authors.lastname: Neri
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D016030:Kidney Transplantation / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D062707:Return to Work / Q000706:statistics & numerical data*; D055815:Young Adult