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Attained Functional Status Moderates Survival Outcomes of Return to Work After Lung Transplantation

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Abstract

Background

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.

Methods

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.

Results

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).

Conclusions

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.

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Abbreviations

ALG:

Antilymphocyte globulin

ATG:

Antithymocyte globulin

BMI:

Body mass index

BOS:

Bronchiolitis obliterans syndrome

CF:

Cystic fibrosis

CI:

Confidence interval

FEV1 :

Forced expiratory volume in 1 s

FVC:

Forced vital capacity

HR:

Hazard ratio

KPS:

Karnofsky Performance Scale

LAS:

Lung allocation score

LTx:

Lung transplantation

UNOS:

United Network for Organ Sharing

6MWD:

Six-minute walk distance

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Authors and Affiliations

  1. Department of Pediatrics, Nationwide Children’s Hospital, College of Medicine, The Ohio State University, 700 Children’s Drive, Columbus, OH, 43205, USA

    Dmitry Tumin, Stephen E. Kirkby & Don Hayes Jr.

  2. Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA

    Stephen E. Kirkby & Don Hayes Jr.

  3. Department of Surgery, College of Medicine, The Ohio State University, Columbus, OH, USA

    Don Hayes Jr.

  4. Department of Anesthesiology, College of Medicine, The Ohio State University, Columbus, OH, USA

    Joseph D. Tobias

  5. Section of Pulmonary Medicine, Nationwide Children’s Hospital, Columbus, OH, USA

    Stephen E. Kirkby & Don Hayes Jr.

  6. Department of Anesthesiology and Pain Medicine, Nationwide Children’s Hospital, Columbus, OH, USA

    Dmitry Tumin & Joseph D. Tobias

Authors
  1. Dmitry Tumin
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  2. Stephen E. Kirkby
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  3. Joseph D. Tobias
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  4. Don Hayes Jr.
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Correspondence to Dmitry Tumin.

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Tumin, D., Kirkby, S.E., Tobias, J.D. et al. Attained Functional Status Moderates Survival Outcomes of Return to Work After Lung Transplantation. Lung 194, 437–445 (2016). https://doi.org/10.1007/s00408-016-9874-3

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  • DOI: https://doi.org/10.1007/s00408-016-9874-3

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