Seventeen observational studies (n=3,391) were included: six prospective (n=981) and 11 cross-sectional (n=2,410). Sample sizes ranged from 20 to 761 participants, with only six studies including more than 100 participants.
Overall quality scores ranged from 20 to 64 per cent (median 40 per cent); internal validity scores ranged between 0 and 50 per cent (median 20 per cent) and D scores ranged between 40 and 100 per cent (median 80 per cent).
Employment rate: The rate of post-transplantation employment as an indicator of social participation ranged from 18 to 82 per cent (which conflicted with pre-transplantation employment rate); five studies reported an increase in post-transplant employment rates; three reported a decrease; and one study reported no change.
The rate of employment compared to that before the onset of renal disease increased in two studies and decreased in three studies.
Predictors of employment status: Three studies found that pre-transplant employment status predicted post-transplant employment status. One study suggested that patients transplanted at an older age were less likely to be employed, however, two studies did not find that age was a predictor of employment status. One study found that diabetic kidney recipients were less likely to work after a kidney transplant. One study found that one year post-transplant was a predictor of post-transplant employment status. One study found that receiving a monthly disability cheque was negatively associated with post-transplant employment status.
Type of transplant or donor source and type of renal replacement therapy before transplantation were not found to predict employment status in two studies.