SEEMEDJ 2020, VOL 4, NO.

1 Employment After Liver Transplantation

Original article

Employment of Patients After Liver Transplantation 1

Anita Holetić 1, Mirjana Đukić 2, Lada Zibar* 3, 4

1
Department of Surgery, Merkur University Hospital, Zagreb, Croatia
2
Health Centre Zagreb – Centre, Zagreb, Croatia
3
Department of Nephrology, Merkur University Hospital, Zagreb, Croatia
4
Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Croatia

*Corresponding author: Lada Zibar, ladazibar @gmail.com

Abstract

Aim: To determine the prevalence of employment of patients after liver transplantation (TX) and the
history of employment, to compare employment with patients’ opinions about their ability to work
and to establish possible reasons for frequent unemployment.
Methods: Ninety-eight respondents participated in the study. They were the first 98 liver transplant
patients who came for a check-up at Merkur University Hospital by the time of the research and
agreed to participate in the study. We created and used a questionnaire about the level of education
and employment prior to and after the liver TX.
Results: Before the diagnosis of liver disease, 59.18 % of the patients were employed, while after liver
TX, at the time of the research, the employment rate decreased to 8.2 %. During the same time span,
the number of retired patients increased from 3.1 % before the diagnosis to 63.3 % after liver TX at the
time of the research. The main reasons for unemployment were poor health due to liver disease and
employers’ unwillingness to hire these patients because of a potential risk of adjustment of working
hours. Median follow-up time after liver TX was 3 years (interquartile range 2 – 6).
Conclusion: Many patients with severe liver disease are unemployed. Liver TX did not increase the
rate of employment of Croatian patients. Patients should be supported by society in finding
appropriate employment.

(Holetić A, Đukić M, Zibar* L. Employment of Patients After Liver Transplantation. SEEMEDJ 2020; 4(1);
49-54)

Received: Feb 13, 2020; revised version accepted: Mar 22, 2020; published: Apr 27, 2020

KEYWORDS: liver transplantation, employment, liver disease, health-related quality of life

49 Southeastern European Medical Journal, 2020; 4(1)

 SEEMEDJ 2020, VOL 4, NO. 1 Employment After Liver Transplantation

Introduction Patients and methods

Liver transplantation (TX) is the standard method The research was conducted at Merkur
of treatment of end-stage liver disease (ESLD), University Hospital in Zagreb in 2018. Ninety-
acute liver failure and selected cases of eight liver transplant patients were selected as
hepatocellular carcinoma. Patients who the subjects of our study. The first 98 patients
underwent TX have better survival rates. Due to who came for a check-up by the time of the
an improvement in the surgical treatment and research were included in the study. The
modern immunosuppressive medicaments, the patients were asked to fill in a questionnaire. The
5-year survival rate increased up to 70 % (1,2,3). questionnaire was created specifically for our
The term “health-related QoL” (HRQOL, health- study by the researcher and it included data
related quality of life) has been in use for several about employment before the diagnosis of liver
decades. This term encompasses the effect of disease, before and after liver TX and at the time
health, i.e. of the illness and of treatment of the of the research. We separately compared
illness on the patient’s physical, cognitive and overall employment and working patients.
social functioning. Ability to work is considered Overall employment included all employed
to be a significant indicator of well-being and participants, even those who were on sick leave.
health status (4,5). Liver TX, as the best method Demographic data and data about liver disease
of treatment of ESLD, improves survival, health were taken from medical records. Seventy (71.4
status, QoL and ability to work (6-8). However, %) participants were male and 28 (28.6 %) were
transplant patients frequently face female. Participants were divided into groups
unemployment, sick leave and retirement. We according to age, with an interval of 10 years.
thus presumed that liver TX, although the best Fifteen participants (15.3 %) were born in the
method for the treatment, unfortunately does period between 1941 and 1950. Most
not improve the patients’ access to employment. participants, 42 (42.9 %) of them, were born
The aims of the study were to determine the between 1951 and 1960, while 33 (33.7 %)
prevalence of employment of liver transplant participants were born between 1961 and 1970.
patients, to compare employment with the The median age of participants was between 58
patients’ opinions about their ability to work and and 67 years (interquartile range, IQR, 48 – 67).
to establish possible reasons for frequent The youngest patient was 26 years old and the
unemployment. There are no available oldest one was 67 years old (Figure 1). Median
published data about the employment of liver follow-up time (from liver TX to the research)
transplant patients in Croatia to date. was 3 years (IQR 2 – 6).

45 42
40
35 33
30
25
n
20 15
15
10
4 3
5 1
0
1941-1950 1951-1960 1961-1970 1971-1980 1981-1990 1991-2000

Birth year

Figure 1. Respondents divided into groups according to age, with an interval of 10 years (N = 98)

50 Southeastern European Medical Journal, 2020; 4(1)

 SEEMEDJ 2020, VOL 4, NO. 1 Employment After Liver Transplantation

for more than a year. Twenty-nine participants

Statistical analysis (29.6 %) waited for liver TX less than six months,
Data were statistically analysed using SPSS while 19 of them (19.4 %) waited between 6
(version 16.0. SPSS Inc., Chicago, IL, USA). months and a year. All the patients selected for
Descriptive statistics included the median with the research underwent liver TX between 2002
IQR for numeric data. Absolute and relative and 2017. At the time of the research (in 2018), 4
frequencies were used for nominal data. participants already had two liver TXs. Most of
Differences were obtained by the Chi-square the participants, 21 of them (21.4 %), underwent
test. Statistical significance was accepted if P liver TX in 2017. In 2016, 17 participants
was < 0.05. underwent liver TX, while 14 of them had liver TX
in 2015.
Results Compared to the period before receiving the
diagnosis of severe liver disease, employment
Ninety-eight patients were included in the among the working patients before liver TX
research. Of 98 participants, 19 completed only decreased by 37.8 % (59.2 % before the
primary education or less (19.4 %), 58 finished diagnosis, 21.4 % before liver TX). Overall
secondary education (59.2 %), 12 had higher employment decreased by 13.2 % (62.2 % before
education qualifications (12.2 %) and 9 had a the diagnosis, 48.9 % thereafter). The number of
university degree (9.2 %). Most of the patients on sick leave (for more than a month)
participants, 50 of them (51 %), waited for liver TX increased by 9 times (3 before the diagnosis, 27
just before TX) (Figure 2)..

60 57

50

40
35

n 30 27 27

19
20
14
9
10
2 3
1 1 1
0
Working full-time Working part-time Sick leave Unemployed Retirement Student

Before diagnosis of liver disease Before TX

Figure 2. Employment of patients (N = 98) before diagnosis of liver disease and just before liver
transplantation (TX)

The number of patients who were working early decreased by 10.2 % (49 % just before TX, 38.8 %
after TX decreased by 9.2 % compared to the early after TX) (Figure 3).
period just before TX (21.4 % just before TX, 12.2
.
% early after TX). Overall employment

51 Southeastern European Medical Journal, 2020; 4(1)

 SEEMEDJ 2020, VOL 4, NO. 1 Employment After Liver Transplantation

60

50
50

40
35

n 30 27 26

19
20
14
11
9
10
2 1 1 1
0
Working full-time Working part-time Sick leave Unemployed Retirement Student

Before TX After TX
P = 0.285
Figure 3. Employment of patients (N = 98) just before and early after liver transplantation (TX)

At the time of the research, the number of patients using sick leave decreased by 7.1 % in
employed patients decreased by 4 % compared the same period (26.5 % early after TX, 19.4 % at
to the period early after TX (12.2 % early after TX, the time of research) (Figure 4).
8.2 % at the time of the research). The number of

70
62
60

50
50

40
n
30 26

19
20
11
9 9
10 7
1 1 1 0
0
Working full-time Working part-time Sick leave Unemployed Retirement Student

After TX At the time of research

Figure 4. Employment of patients (N = 98) early after liver transplantation (TX) and at the time of the
research

52 Southeastern European Medical Journal, 2020; 4(1)

 SEEMEDJ 2020, VOL 4, NO. 1 Employment After Liver Transplantation

At the time of the research, the number of patients on sick leave increased by 16.3 % (3.1 %
employed patients decreased by 51 % compared before the diagnosis, 19.4 % at the time of the
to the period before the diagnosis of ESLD (59.2 research) and the number of retired patients
% before the diagnosis, 8.2 % at the time of increased by 60.2 % (3.1 % before the diagnosis,
research). In the same period, the number of 63.3 % at the time of the research) (Figure 5).

70
62
60 57

50

40
n
30 27
19
20

7 9 9
10
1 1 3 1 0
0
Working full-time Working part-time Sick leave Unemployed Retirement Student

Before diagnosis of liver disease At the time of research P = 0.773

Figure 5. Employment of patients (N = 98) before the diagnosis of liver disease and at the time of the
research

At the time of the research, 8 participants were similar results regarding employment after liver
employed (8.2 %), while 34 felt capable of TX. In 2018, E. R. Waclawski and P. Noone
working (34.7 %). Nineteen participants felt published a systematic review of the impact of
capable of working full-time, while 15 felt liver TX on employment (9). They included 13
capable of working part-time (P = 0.773). As the studies published from January 2001 to
main reason for unemployment, 22 patients (22.5 December 2016. All the studies they found
%) reported poor health due to ESLD, 4 of them showed either a fall in the employment rate or
(4.1 %) claimed that employers did not want to no effect on the employment rate. Overall
hire workers who underwent liver TX, 22 of them employment ranges from 18 to 44 % after liver
reported some other reason, while 41 did not TX, which was higher than in our research.
give an answer. Employment after liver TX was lower than after
other organ TX, such as kidney or heart TX, but
Discussion higher than after lung TX, as shown in a study
which included 281 kidney, heart, liver and lung
This is the first research on employment of liver transplant patients (10). Compared to the
TX patients in Croatia. Just before liver TX, research about employment after kidney TX in
overall employment had already decreased by Croatia, conducted at the Clinical Hospital
13.2 % compared to the period before receiving Centre Osijek in 2017, employment after liver TX
the diagnosis of severe liver disease. Although at the time of the research was lower than after
patients presumably have a better health status kidney TX (namely 18.1 %), which corresponded
and QoL after liver TX, the number of employed to the results mentioned earlier (11).
patients early after liver TX decreased by 9.2 %
compared to the period just before liver TX. At What was the reason of unemployment after
the time of the research, only 8.2 % of patients TX? After TX, patients need to take
were employed. Many researchers described immunosuppressive medicaments for the rest of

53 Southeastern European Medical Journal, 2020; 4(1)

 SEEMEDJ 2020, VOL 4, NO. 1 Employment After Liver Transplantation

their lives. Immunosuppressive therapy has did not want to hire the patients who underwent
adverse effects, including infections, diabetes TX.
mellitus, nephrotoxicity, cardiovascular disease
and osteoporosis (12). Moreover, patients have a Conclusion
mental burden because of the disease.
However, our study has shown that 8.2 % of the Even though TX improves the patients’ health
participants were employed, while 34.7 % of status and survival, it is necessary to ensure that
them felt capable of working, which indicates a they have a better QoL and allow them to return
significant disproportion. The question is what to their usual activities, including appropriate
caused that disproportion. As the main reason employment. Social support is needed to
for unemployment, the majority of respondents improve the chances of employment.
reported poor health due to ESLD, while the
.
minority of respondents claimed that employers
Rogiers X, Van Vlierberghe H, Verhelst X. Quality
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