Long Term Employment Following Heart Transplantation in the United States

Purpose Employment is an important metric of post-transplant functional status and quality of life, yet remains poorly described after heart transplant. We sought to characterize the prevalence of employment following heart transplantation and identify patients at risk for post-transplant unemployment. Methods Adults undergoing single-organ heart transplantation (2007-2016) were evaluated using the UNOS database. Univariate analysis was stratified by employment status at one year post-transplant. A Kaplan-Meier analysis evaluated time to start of employment while Fine-Gray competing risk regression was used for risk adjustment. Results Of 11,088 heart transplant recipients, 22.0% of survivors were employed and 71.3% unemployed one year post-transplant. Overall employment rate of survivors increased to 32.9% by year two. Employed individuals were more likely white (70.9% vs. 60.4%, p Conclusion Over 20% of heart transplant patients are employed at one year and 30% at two years, while 60% of those working pre-transplant return to work. Postoperative complications, race, education and insurance status are all drivers of employment. Quality improvement focused on addressing socioeconomic disparities may maximize functional status post-transplant.