心臟移植術後病人重返工作現況及相關因素之探討

Abstract

背景：心臟移植後重返工作的能力被視為重要的預後指標，但台灣相關研究數量有限且部分年代久遠，故本研究目的為了解近年來台灣心臟移植後病人重返工作現況，並探討相關預測因素。 方法：本研究為世代研究，以連續取樣於台灣北部心臟移植數量第一的醫學中心，針對2015年至2020年接受心臟移植後兩年之存活病人進行收案，以面對面訪談與病歷查檢方式進行資料收集，包括人口學資料、移植前與移植後疾病相關變項、及移植後重返工作情形。 結果：本研究共納入77人，病人平均移植年齡49.9±10.7歲，平均移植時間5.5±1.7年，女性有15人（19.5%）。心臟移植後兩年內重返工作人數有33人（42.9%），18人 (23.4%) 在移植後第1年重返工作，15人 (19.5%) 在移植後第2年重返工作，在心臟移植術後重返工作的時間點比較上，第一年重返工作人數百分比與第二年人數百分比並未達顯著差異（p=0.728），此外，病人平均耗時約11個月才得以重返工作 (中位數11個月、四分位距5-14個月），在33位重返工作病人的移植前後工時比較上，90.9%病人 (n=30) 移植前工時≧8小時，移植後僅有48.5% (n=16) 工時≧8小時，達顯著差異（p<0.001）。由羅吉斯迴歸模型進行心臟移植後兩年內重返工作的危險因子分析，結果發現在調整移植年齡、每月家庭總收入、移植前有無工作、移植前中斷工作時間、查爾森共病症指標、加護病房住院天數、總住院天數、移植後2年內有無排斥反應後，心臟移植前有工作者，其重返工作的勝算顯著較高（調整後勝算比20.6；信賴區間2.07-205.8），移植後兩年內有排斥反應者，其重返工作的勝算會下降80%（調整後勝算比0.2；信賴區間0.04-0.81）。若聚焦於54位移植前有工作者的次分析，結果顯示在調整婚姻狀態、移植前工作階級、查爾森共病症指標、心臟移植疾病嚴重度分級、移植前有無機械式循環輔助裝置、加護病房住院天數、及移植後2年內有無排斥反應後，相較於自雇者，移植前為藍領工作者，其重返工作的勝算會下降90%（調整後勝算比0.1；信賴區間0.01-0.86）。 結論：心臟移植兩年後約有42.9%的病人可重返工作崗位，比例並不高，移植前有工作及移植後有排斥反應是心臟移植病人術後重返工作的預測因子，可做為推動重返工作計畫時的考量重點，未來研究需進一步探討如何協助心臟移植術後病人重返工作崗位，重建其職業生活。

Background: Returning to work after heart transplantation is an important prognostic indicator of recovery. Despite its significance, the literature on this research is limited and outdated. This study aimed to understand the incidence of returning to work and to identify its predictors among patients receiving heart transplantation over a two-year period in Taiwan. Methods: This cohort study consecutively enrolled participants who survived at least two years following heart transplantation from 2015 to 2020 at a medical center in northern Taiwan. Data on participants’ demographic, clinical medical data, and employment status post-transplantation were collected through face-to-face interviews and were abstracted from medical records. Results: A total of 77 patients were included, with a mean (SD) age at transplantation of 49.9 (10.7) years and a mean (SD) duration of transplantation surgery of 5.5 (1.7) years. There were 19.5% (n=15) being female. After heart transplantation two years, 33 participants (42.9%) returned to work; 18 (23.4%) returned to work in the first year and 15 (19.5%) in the second year. There was no significant difference in return-to-work rates between the first and second years (p=0.728). The median (IQR) time to return to work was 11 (5-14) months. For those who were employed after heart transplantation (n=33), 90.9% (n=30) of participants worked more than 8 hours daily before surgery; however, only 48.5% (n=16) of participants reached 8 hours of work per day after transplantation, showing a statistically significant reduction (p<0.001). Logistic regression analysis revealed that participants employed prior to transplantation were more likely to return to work (adjusted odds ratio 20.6; 95% CI 2.07-205.8), whereas those experiencing rejection within two years after heart transplantation had 80% lower odds of returning to work (adjusted odds ratio 0.2; 95% CI 0.04-0.81), independent of age at transplant, total monthly household income, pre-transplant employment status, time off work pre-transplant, Charlson comorbidity index, ICU length of stay, total length of hospital stay, presence of rejection within two years post-transplant. Focusing on the 54 patients who were employed before transplantation, the analysis showed that, compared to self-employed participants, blue-collar workers had 90% reduced odds of returning to work (adjusted odds ratio 0.1; 95% Cl 0.01-0.86), adjusting for marital status, pre-transplant job classification, Charlson comorbidity index, severity classification of heart transplant disease, presence of mechanical circulatory support device pre-transplant, ICU length of stay, and presence of rejection within two years post-transplant. Conclusions: For patients who underwent heart transplantation over a two-year period, approximately 42.9% were able to return to work, a relatively modest rate. Employment status prior to transplantation and post-transplantation rejection episodes are significant predictors of returning to work. These findings should be considered in developing interventions aimed at facilitating the reintegration of transplant patients into the workforce. Further research is necessary to devise strategies that can support transplant patients in their return to work.