Petersen Emily, Baird Bradley C, Barenbaum Lev L, Leviatov Alexander, Koford James K, Shihab Fuad, Goldfarb-Rumyantzev Alexander S
Department of Medicine, University of Utah School of Medicine, Salt Lake City, USA.
Clin Transplant. 2008 Jul-Aug;22(4):428-38. doi: 10.1111/j.1399-0012.2008.00803.x. Epub 2008 Feb 25.
With the improved median survival of kidney transplant recipients, there has been an increased focus on quality of life after transplantation. Employment is a widely recognized component of quality of life. To date, no study has demonstrated a link between post-transplant employment status and recipient and allograft survival after transplant.
The records from the United States Renal Data System (USRDS) and the United Network for Organ Sharing (UNOS) from January 1, 1995, through December 31, 2002, were examined in this retrospective study. Two outcomes, allograft survival time (time between the transplantation and allograft failure or censor) and recipient survival time (time between the transplantation and recipient death or censor), were analyzed using Cox models adjusted for potential confounding factors.
Compared to patients working full time at the time of transplantation, those not working by choice have a greater risk to graft [hazard ratio (HR) 1.27, p < 0.001] but not to recipient survival. A similar trend was observed in patients not working at 12 months post-transplant (HR 1.30, p < 0.001 for graft survival but not for recipient survival). However, at five-yr post-transplant not working by choice was protective to the graft (HR 0.47, p < 0.01) as compared to working full time. Results of the analysis in the patient subgroups based on the comorbidities and the overall health status were similar.
Employment status at the time of transplantation and in post-transplant period has a strong and independent association with the graft and recipient survival. Full time employment at the time of transplant and at one-yr post-transplant is associated with lower risk for graft failure and recipient mortality. However, working beyond the time covered by Medicare might be associated with potential risk for graft survival.
随着肾移植受者中位生存期的延长，人们越来越关注移植后的生活质量。就业是生活质量中一个广泛认可的组成部分。迄今为止，尚无研究表明移植后就业状况与移植后受者及移植物存活之间存在关联。
在这项回顾性研究中，查阅了美国肾脏数据系统（USRDS）和器官共享联合网络（UNOS）从1995年1月1日至2002年12月31日的记录。使用针对潜在混杂因素进行调整的Cox模型分析了两个结局，即移植物存活时间（移植至移植物失败或截尾的时间）和受者存活时间（移植至受者死亡或截尾的时间）。
与移植时全职工作的患者相比，自愿不工作的患者移植物失败风险更高[风险比（HR）1.27，p < 0.001]，但对受者存活无影响。移植后12个月不工作的患者也观察到类似趋势（移植物存活的HR为1.30，p < 0.001，受者存活无此情况）。然而，与全职工作相比，移植后5年自愿不工作对移植物有保护作用（HR 0.47，p < 0.01）。基于合并症和总体健康状况的患者亚组分析结果相似。
移植时及移植后的就业状况与移植物和受者存活密切且独立相关。移植时及移植后1年全职工作与移植物失败和受者死亡风险较低相关。然而，在医疗保险覆盖时间之后仍工作可能与移植物存活的潜在风险相关。
