Long-term work participation among cystic fibrosis patients undergoing lung transplantation

Background: Patients with cystic fibrosis (CF) experience obstacles to employment, regardless of whether they have undergone lung transplantation (LTx). We investigated socioeconomic and clinical factors predicting long-term employment outcomes in CF patients receiving LTx. Methods: Data from the United Network for Organ Sharing registry were used to identify CF patients 18-59 years-old who received LTx between 2000 and 2010 and survived greater than 5 years. Long-term employment status was determined by center-reported follow-up data on patients working for income, collected at the 5th transplant anniversary. After multiple imputation to complete missing data on covariates, multivariable logistic regression was used to identify associations between characteristics at or after LTx and long-term work participation. Results: There were 745 patients who met inclusion criteria and contributed employment data within 365 days of their 5th LTx anniversary. In this cohort, 48% (358/745) were working for income 5 years after LTx. Younger age, male gender, better pulmonary function attained post-transplant, pre-transplant work participation, and private health insurance (compared to government Medicaid or Medicare insurance) at the time of transplant predicted greater odds of post-transplant employment. Conclusions: Lack of work experience and reliance on government health insurance at the time of transplant predict lower long-term work participation among LTx recipients with CF. By contrast, long-term employment outcomes were not negatively affected by comorbidities at or after transplantation in this cohort. Despite resolving some physiological obstacles to employment in patients with CF, LTx may introduce new socioeconomic barriers to employment. (C) 2016 European Cystic Fibrosis Society. Published by Elsevier B.V. All rights reserved.