title: 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 1 s (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 1 year post transplant should be considered.
authors.affiliation: Department of Pediatrics, Nationwide Children's Hospital, College of Medicine, The Ohio State University, 700 Children's Drive, Columbus, OH, 43205, USA. Dmitry.Tumin@nationwidechildrens.org.|Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA. Dmitry.Tumin@nationwidechildrens.org.
authors.forename: Dmitry
authors.initials: D
authors.lastname: Tumin
authors.affiliation: Department of Pediatrics, Nationwide Children's Hospital, College of Medicine, The Ohio State University, 700 Children's Drive, Columbus, OH, 43205, USA.|Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA.|Section of Pulmonary Medicine, Nationwide Children's Hospital, Columbus, OH, USA.
authors.forename: Stephen E
authors.initials: SE
authors.lastname: Kirkby
authors.affiliation: Department of Anesthesiology, College of Medicine, The Ohio State University, Columbus, OH, USA.|Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA.
authors.forename: Joseph D
authors.initials: JD
authors.lastname: Tobias
authors.affiliation: Department of Pediatrics, Nationwide Children's Hospital, College of Medicine, The Ohio State University, 700 Children's Drive, Columbus, OH, 43205, USA.|Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA.|Department of Surgery, College of Medicine, The Ohio State University, Columbus, OH, USA.|Section of Pulmonary Medicine, Nationwide Children's Hospital, Columbus, OH, USA.
authors.forename: Don
authors.initials: D
authors.lastname: Hayes
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D053208:Kaplan-Meier Estimate; D017567:Karnofsky Performance Status; D016040:Lung Transplantation / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D065840:Protective Factors; D020127:Recovery of Function; D012042:Registries; D062707:Return to Work / Q000706:statistics & numerical data*; D015996:Survival Rate; D013997:Time Factors; D014478:Unemployment / Q000706:statistics & numerical data; D055815:Young Adult
keywords: Employment; Functional status; Lung transplantation; Survival