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      Predictors of return to work after kidney transplantation: a 12-month cohort of the Japan Academic Consortium of Kidney Transplantation study

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          Abstract

          Objectives

          To investigate the cumulative return-to-work (RTW) rate and to identify predictors of employment after kidney transplantation (KT).

          Design

          Retrospective, outpatient-based cohort study.

          Setting

          This was a single-centre study of the largest Japanese kidney transplant centre.

          Participants

          We selected Japanese kidney transplant recipients aged 20–64 years who were employed in paid jobs at the time of transplantation and who visited an outpatient clinic from December 2017 to March 2018. From 797 patients, we evaluated 515 in this study.

          Interventions

          We interviewed patients at an outpatient clinic and investigated the timing and predictors of RTW using logistic regression models.

          Primary and secondary outcome measures

          The primary outcome was the cumulative RTW rate, and the secondary outcome was to investigate the predictors of RTW after KT.

          Results

          Among the 515 included recipients, the cumulative overall partial/full RTW rates at 2, 4, 6 and 12 months were 22.3%, 59.0%, 77.1% and 85.0%, respectively. The median duration from transplantation to RTW was 4 months. Regarding partial/full RTW, according to the multivariable analysis including all variables, male sex was a greater predictor for RTW than female sex (OR 2.05, 95% CI 1.32 to 3.20), and a managerial position was a greater predictor than a non-managerial position (OR 2.23, 95% CI 1.42 to 3.52). Regarding full RTW, male sex (OR 1.95, 95% CI 1.25 to 3.06) and managerial position (OR 1.95, 95% CI 1.25 to 3.06) were also good predictors.

          Conclusions

          The cumulative RTW rate was 85.0% 1-year post-transplantation. Given that cumulative RTW rates varied by sex and position, transplant and occupational physicians should support kidney transplant recipients in the aspect of returning to work.

          Trial registration number

          UMIN000033449

          Related collections

          Most cited references33

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          Returning to work after sick leave due to cancer: a 365-day cohort study of Japanese cancer survivors

          Purpose More employees are experiencing a cancer diagnosis during their working-age years, yet there have been no large-scale Japanese studies investigating sick leave due to cancer. We clarified differences in the cumulative partial and full return to work (RTW) rates between different cancer types among Japanese cancer survivors. Methods Data on Japanese employees who experienced an episode of sick leave due to clinically certified cancer diagnosed between 1 January 2000 and 31 December 2011 were obtained from an occupational health register. Subject outcomes within the 365-day period following their initial day of sick leave were utilized for this study. We investigated the cumulative partial/full and full RTW rates by using survival analysis with competing risks and predictors of time to RTW by a Fine-Gray proportional hazard regression model. Results One thousand two hundred seventy-eight subjects (1033 males and 245 females) experienced their first episode of sick leave due to cancer during the 12-year follow-up period. Of the subjects, 47.1 % returned to work full time within 6 months of their initial day of sick leave absence, and 62.3 % by 12 months. The cumulative RTW rate varied significantly by cancer type. There were considerable differences in the range of cumulative full RTW rates between the two categories (“lower full RTW rate” groups (“lung,” “hepatic, pancreatic,” “esophageal,” and “blood” cancer groups) vs. “higher full RTW rate” groups (“gastric,” “intestinal,” “breast,” “female genital,” “male genital,” “urinary”): 6.3 to 14.3 % vs. 11.4 to 28.3 % at 60 days, 10.6 to 22.4 % vs. 27.0 to 50.0 % at 120 days, 21.3 to 34.7 % vs. 38.5 to 65.4 % at 180 days, 34.3 to 42.9 % vs. 66.0 to 79.5 % at 365 days). Additionally, older age may be associated with a longer time to full RTW. Conclusions More than half of the subjects returned to work full-time within the 365-day period following their initial day of sick leave, with cumulative RTW rates varying by cancer type. Older employees may require a longer time to full RTW. Implications of Cancer Survivors It is very important for companies (especially small- and medium-sized companies) to establish and improve their RTW support system for cancer survivors, with knowledge that the median time to RTW is expected to be at least a few months.
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            From dialysis to transplantation: a 5-year longitudinal study on self-reported quality of life

            Background Little is known how health related quality of life (HRQOL) change in the transition from dialysis to renal transplantation (RTX). Longitudinal data addressing the patient-related outcomes are scarce, and particularly data regarding kidney-specific HRQOL are lacking. Thus, the aim of the current study was to assess HRQOL in patients followed from dialysis to RTX. Furthermore, to compare HRQOL in RTX patients and the general population. Methods In a prospective study, HRQOL was measured in a cohort of 110 patients (median age 53.5 (IQR 39–62) years, GFR 54 (45–72) ml/min/1.73 m2) in dialysis and after RTX using the self-administered Kidney Disease and Quality of Life Short Form version 1.3 (KDQOL-SF). Generic HRQOL in the RTX patients was compared to that of the general population (n = 5903) using the SF-36. Clinical important change after RTX was defined as difference in HRQOL of SD/2. Results Follow-up time was 55 (IQR 50–59) months, and time after RTX was 41 (34–51) months. Four of nine domains in kidney-specific HRQOL improved after RTX, i.e. burden of kidney disease, effect of kidney disease, symptoms and work status. In SF-36, general health, vitality, social function and role physical improved after RTX, but none of the domains improved sufficiently to be regarded as clinically relevant change. There were highly significant differences in HRQOL between RTX patients and the general population after adjustment for age and gender for all items of SF-36 except for bodily pain and mental health. Conclusions HRQOL improved in the transition from dialysis to transplantation, but clinical relevant change was only obtained in the kidney specific domains. HRQOL was perceived considerably poorer in RTX patients than in the general population. Our observations point to the need of improving HRQOL even after RTX, and should encourage further longitudinal research and clinical attention during treatment shift.
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              Swedish Council on Technology Assessment in Health Care (SBU). Chapter 4. Methodological aspects in sickness-absence research.

              Several methodological aspects concerning research on sickness absence and disability pension are noteworthy, including: empirical research is being conducted within many different disciplines using various study designs; progress in theory development has been slow and weak; several outcome measures are used; terminology varies widely; and comparative research is difficult to conduct since insurance systems differ over time and among nations and employers.
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                Author and article information

                Journal
                BMJ Open
                BMJ Open
                bmjopen
                bmjopen
                BMJ Open
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                2044-6055
                2019
                3 October 2019
                : 9
                : 10
                : e031231
                Affiliations
                [1 ] departmentDepartment of Urology , Tokyo Women’s Medical University , Shinjuku-ku, Japan
                [2 ] departmentDepartment of Kidney Transplantation , Shonan Kamakura General Hospital , Kamakura, Japan
                [3 ] departmentDepartment of Public Health , Juntendo University , Bunkyo-ku, Japan
                [4 ] departmentDepartment of Organ Transplant Medicine , Tokyo Women’s Medical University , Shinjuku-ku, Japan
                [5 ] Tokyo Women’s Medical University , Shinjuku-ku, Japan
                Author notes
                [Correspondence to ] Dr Masayoshi Okumi; okumi@ 123456twmu.ac.jp
                Author information
                http://orcid.org/0000-0001-8356-9646
                Article
                bmjopen-2019-031231
                10.1136/bmjopen-2019-031231
                6797409
                31585975
                b211427c-be80-4937-8d81-12fcf78ddd10
                © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

                This is an open access article 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, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

                History
                : 28 April 2019
                : 02 August 2019
                : 21 August 2019
                Categories
                Occupational and Environmental Medicine
                Original Research
                1506
                1716
                Custom metadata
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                Medicine
                end-stage renal disease,kidney transplantation,return to work
                Medicine
                end-stage renal disease, kidney transplantation, return to work

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