Department of Cardiothoracic Surgery-Department of Surgery, Baylor Scott & White Health, affiliated with Texas A&M, Temple, Texas, USA.
College of Medicine, Texas A&M Health Science Center, Temple, Texas, USA.
J Heart Lung Transplant. 2018 May;37(5):604-610. doi: 10.1016/j.healun.2018.01.1307. Epub 2018 Jan 31.
Recipient-related factors, such as education level and type of health insurance, are known to affect heart transplantation outcomes. Pre-operative employment status has shown an association with survival in abdominal organ transplant patients. We sought to evaluate the effect of work status of heart transplant (HTx) recipients at the time of listing and at the time of transplantation on short- and long-term survival.
We evaluated the United Network for Organ Sharing (UNOS) registry for all adult HTx recipients from 2001 to 2014. Recipients were grouped based on their work status at listing and at heart transplantation. Kaplan-Meier estimates illustrated 30-day, 1-year, 5-year, and 10-year survival comparing working with non-working groups. The Cox proportional hazards regression model was applied to adjust for covariates that could potentially confound the post-transplantation survival analysis.
Working at listing for HTx was not significantly associated with 30-day and 1-year survival. However, 5- and 10-year mortality were 14.5% working vs 19.8% not working (p < 0.0001) and 16% working vs 26% not working (p < 0.0001), respectively. Working at HTx appeared to be associated with a survival benefit at every time interval, with a trend toward improved survival at 30 days and 1 year and a significant association at 5 and 10 years. Kaplan-Meier analysis demonstrated a 5% and 10% decrease in 5- and 10-year mortality, respectively, for the working group compared with the group not working at transplantation. The Cox proportional hazards regression model showed that working at listing and working at transplantation were each associated with decreased mortality (hazard ratio [HR] = 0.8, 95% confidence interval [CI] 0.71 to 0.91; and HR = 0.76, 95% CI 0.65 to 0.89, respectively).
This study is the first analysis of UNOS STAR data on recipient work status pre-HTx demonstrating: (1) an improvement in post-transplant survival for working HTx candidates; and (2) an association between working pre-HTx and longer post-HTx survival. Given that work status before HTx may be a modifiable risk factor for better outcomes after HTx, we strongly recommend that UNOS consider these important findings for moving forward this patient-centered research on work status. Working at listing and working at HTx are associated with long-term survival benefits. The association may be reciprocal, where working identifies less ill patients and also improves well-being. Consideration should be given to giving additional weight to work status during organ allocation. Work status may also be a modifiable factor associated with better post-HTx outcomes.
受者相关因素，如教育水平和健康保险类型，已知会影响心脏移植的结果。术前就业状况与腹部器官移植患者的存活率有关。我们试图评估心脏移植（HTx）受者在列入名单时和移植时的工作状况对短期和长期生存的影响。
我们评估了 2001 年至 2014 年期间所有成人 HTx 受者的美国器官共享网络（UNOS）登记处。根据列入名单和心脏移植时的工作状况对受者进行分组。Kaplan-Meier 估计表明，与非工作组相比，工作组在 30 天、1 年、5 年和 10 年的生存率。应用 Cox 比例风险回归模型来调整可能混淆移植后生存分析的协变量。
在 HTx 时工作与 30 天和 1 年的生存率无关。然而，5 年和 10 年的死亡率分别为 14.5%工作与 19.8%不工作（p<0.0001）和 16%工作与 26%不工作（p<0.0001）。在每个时间间隔，工作似乎与生存获益相关，在 30 天和 1 年时呈现出生存获益的趋势，在 5 年和 10 年时具有显著关联。Kaplan-Meier 分析显示，与未工作组相比，工作组在 5 年和 10 年的死亡率分别降低了 5%和 10%。Cox 比例风险回归模型显示，列入名单时工作和移植时工作均与死亡率降低相关（风险比[HR] = 0.8，95%置信区间[CI] 0.71 至 0.91；HR = 0.76，95%CI 0.65 至 0.89）。
这是对 UNOS STAR 数据中受者术前工作状态的首次分析，表明：（1）工作 HTx 候选者的移植后生存得到改善；（2）HTx 前工作与 HTx 后较长的生存时间之间存在关联。鉴于 HTx 前的工作状态可能是 HTx 后更好结果的可改变风险因素，我们强烈建议 UNOS 考虑这些重要的发现，以推动以患者为中心的工作状态研究。列入名单时工作和 HTx 时工作与长期生存获益相关。这种关联可能是相互的，即工作识别出病情较轻的患者，并改善了健康状况。在器官分配时，应考虑给予工作状态更多权重。工作状态也可能是与 HTx 后结果改善相关的可改变因素。
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