Effects of kidney transplantation on labour market outcomes in Sweden

Background Kidney transplantation is considered a superior treatment for end stage renal disease compared to dialysis although little is known about the wider effects, especially on labour market outcomes. The objective is to estimate the treatment effect of kidney transplantation compared to dialysis on labour market outcomes, controlling for the nonrandom selection into treatment. Method The average treatment effect is estimated using an inverse-probability weighting regression adjustment approach on all patients in renal replacement therapy 1995-2012. Results Kidney transplantation is associated with a treatment advantage over dialysis on employment, labour force participation, early retirement, and labour income. The probability of being employed 1 year after treatment is 21 (CI 16-25) percentage points higher for transplantation. The positive effect increases to 38 (CI 30-46) percentage points after 5 years, mainly due to worsening outcomes on dialysis. The effect on labour income is mainly mediated through employment probability. The productivity gains of transplantation compared to dialysis amounts to €33 000 over 5 years. Conclusions Transplantation is superior to dialysis in terms of potential to return to work as well as in terms of labour income and risk of early retirement, after controlling for treatment selection. This positive effect increases over time after transplantation. Corresponding author: Johan Jarl, Box 117, 221 00 Lund, Sweden, johan.jarl@med.lu.se Authorship: All authors participated in the design of the study, interpretation of the results and write-up. JJ conducted the analyses and drafted the first version. All authors have approved the final version. Disclosure: The authors declare no conflicts of interest. The results presented in this paper have not been published previously in whole or part. Funding: Financial support from Region Skåne, Sweden (regional public health care provider), and the Government Grant for Clinical Research ("ALF") is greatly acknowledged. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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