What factors are associated with work after cardiothoracic transplant? A systematic review

Cardiothoracic transplantation is a lifesaving intervention for end-stage cardiopulmonary disease, however true recovery requires comprehensive social reintegration, including the opportunity for work participation. This systematic review (PROSPERO CRD42025634363) reports rates of work and characterises factors associated with working post-cardiothoracic transplant. Research questions were informed through consultation with the cardiothoracic transplant community and guided by a work and health perspective. Five databases (Ovid MEDLINE, Ovid Embase, CINAHL, Web of Science, PsycINFO) were searched for studies published 2000-2024. Quantitative and mixed-methods studies reporting post-transplant work outcomes were included. Screening, data extraction, and risk of bias assessment were conducted independently by two reviewers, with discrepancies resolved by consensus. Thirty-five manuscripts, representing 32 unique studies and 23,511 cardiothoracic transplant recipients (12,062 heart; 11,400 lung; 49 heart and lung), were included. Post-transplant employment rates at one year were 22-44% for heart and 28% for lung transplant recipients. At five years, 29.4-30% heart and 48% lung transplant recipients were employed. Return-to-work rates varied widely (heart 28-88%; lung 18-83%), with median time to return ranging from 5 to >31 months. Factors associated with higher work participation included pre-transplant employment, younger age, higher education, and male sex. Lower participation was associated with post-transplant complications, fatigue, and depression. Other work-related outcomes including work ability, absenteeism, and employer support were inconsistently reported. Methodological limitations were common, particularly reliance on self-reported, unvalidated work outcome measures and heterogeneous follow-up time points. Addressing modifiable determinants through targeted interventions is critical to improving work participation among cardiothoracic transplant recipients.