Socio-Occupational Aspects in Liver Transplant Candidates and Recipients: A Retrospective Cohort Study

Liver transplantation (LT) restores survival and quality of life in patients with end-stage liver disease, yet return-to-work (RTW) remains challenging. Employment status before transplantation is a major predictor of post-LT reintegration, but socio-professional factors are rarely assessed during the pre-transplant period, particularly in the post-COVID era.

We retrospectively included all adult LT candidates, aged 18-64 years and eligible to work, who performed elective pre-transplant evaluation at Rennes University Hospital between June 2022 and December 2023. Retired patients were excluded. We aimed to investigate the socio-professional aspects of working age liver transplant candidates and characterize their socio-professional trajectory one year after LT. Socio-demographic, medical, and occupational data were collected at baseline and one-year post-LT. Working patients were defined as those engaged in income-generating activity. Logistic regression was used to identify factors associated with employment before and after LT.

Among 141 LT candidates (65% male, median age 56), 31% [24-40] were working at evaluation. Working patients were younger, less frequently manual workers, and more often held higher educational levels or access to remote work. In multivariable analysis, higher education independently predicted pre-transplant working status (aOR 2.99, 95%CI 1.18-7.63; p = 0.02). Eighty-six patients underwent LT. At one year, RTW prevalence was 31 [21-41] %, with no increase compared to baseline. RTW was more likely among those working before LT (aOR 9.67, 95%CI 3.06-35.09; P < 0.001) and inversely associated with younger age and post-LT vascular complication. Patients resuming work reported higher quality of life.

In this cohort, only one-third of LT candidates were working, and RTW at one year remained limited. Pre-transplant working status and education level were key determinants, while disability insurance hindered reintegration. Early socio-professional support, workplace adaptations, and occupational health consultation are critical to optimize post-transplant occupational activity.