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Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Apr 14, 2016; 22(14): 3701-3711
Published online Apr 14, 2016. doi: 10.3748/wjg.v22.i14.3701
From prolonging life to prolonging working life: Tackling unemployment among liver-transplant recipients
Fredrik Åberg
Fredrik Åberg, Transplantation and Liver Surgery Clinic, HUCH Meilahti Hospital, Helsinki University, 00029 HUS, Finland
Author contributions: Åberg F solely contributed to this work.
Conflict-of-interest statement: The author declares no conflict of interests for this article.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Fredrik Åberg, MD, Transplantation and Liver Surgery Clinic, HUCH Meilahti Hospital, PB 372, 00029 HUS, Finland. fredrik.aberg@helsinki.fi
Telephone: +358-40-5780625
Received: January 27, 2016
Peer-review started: January 30, 2016
First decision: February 18, 2016
Revised: February 19, 2016
Accepted: March 1, 2016
Article in press: March 2, 2016
Published online: April 14, 2016
Processing time: 61 Days and 17.8 Hours
Abstract

Return to active and productive life is a key goal of modern liver transplantation (LT). Despite marked improvements in quality of life and functional status, a substantial proportion of LT recipients are unable to resume gainful employment. Unemployment forms a threat to physical and psychosocial health, and impairs LT cost-utility through lost productivity. In studies published after year 2000, the average post-LT employment rate is 37%, ranging from 22% to 55% by study. Significant heterogeneity exists among studies. Nonetheless, these employment rates are lower than in the general population and kidney-transplant population. Most consistent employment predictors include pre-LT employment status, male gender, functional/health status, and subjective work ability. Work ability is impaired by physical fatigue and depression, but affected also by working conditions and society. Promotion of post-LT employment is hampered by a lack of interventional studies. Prevention of pre-LT disability by effective treatment of (minimal) hepatic encephalopathy, maintaining mobility, and planning work adjustments early in the course of chronic liver disease, as well as timely post-LT physical rehabilitation, continuous encouragement, self-efficacy improvements, and depression management are key elements of successful employment-promoting strategies. Prolonging LT recipients’ working life would further strengthen the success of transplantation, and this is likely best achieved through multidisciplinary efforts ideally starting even before LT candidacy.

Keywords: Employment; Workforce; Transplantation; Quality of life; Work ability

Core tip: Outcomes after liver transplantation are steadily improving and transplant recipients are increasingly able to resume normal life. However, a considerable number of recipients are unable to resume work, and this represents an increasing challenge in the field of liver transplantation. This paper discusses possible barriers to post-transplant employment, and means to increase return-to-work among liver transplant recipients.