title: From prolonging life to prolonging working life: Tackling unemployment among liver-transplant recipients.
abstract: Return to active and productive life is a key goal of modern liver transplantation (LT). Despite marked improvements in quality of life and functional status, a substantial proportion of LT recipients are unable to resume gainful employment. Unemployment forms a threat to physical and psychosocial health, and impairs LT cost-utility through lost productivity. In studies published after year 2000, the average post-LT employment rate is 37%, ranging from 22% to 55% by study. Significant heterogeneity exists among studies. Nonetheless, these employment rates are lower than in the general population and kidney-transplant population. Most consistent employment predictors include pre-LT employment status, male gender, functional/health status, and subjective work ability. Work ability is impaired by physical fatigue and depression, but affected also by working conditions and society. Promotion of post-LT employment is hampered by a lack of interventional studies. Prevention of pre-LT disability by effective treatment of (minimal) hepatic encephalopathy, maintaining mobility, and planning work adjustments early in the course of chronic liver disease, as well as timely post-LT physical rehabilitation, continuous encouragement, self-efficacy improvements, and depression management are key elements of successful employment-promoting strategies. Prolonging LT recipients' working life would further strengthen the success of transplantation, and this is likely best achieved through multidisciplinary efforts ideally starting even before LT candidacy.
authors.affiliation: Fredrik Åberg, Transplantation and Liver Surgery Clinic, HUCH Meilahti Hospital, Helsinki University, 00029 HUS, Finland.
authors.forename: Fredrik
authors.initials: F
authors.lastname: Åberg
mesh_terms: D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects / Q000523:psychology / Q000534:rehabilitation*; D016272:Occupational Health; D011788:Quality of Life; D062707:Return to Work; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014478:Unemployment; D014938:Work Capacity Evaluation
keywords: Employment; Quality of life; Transplantation; Work ability; Workforce