Transplantation and Employment Earnings in Kidney Transplant Recipients

Importance: Kidney transplantation improves survival and quality of life for individuals with end-stage kidney disease (ESKD). However, its effect on objective economic outcomes, such as employment income, remains insufficiently studied. Objective: To quantify changes in employment income before and after kidney transplantation in Canada using linked administrative health and tax data. Design, Setting, and Participants: This population-based cohort study included nationwide data from Canadian adults receiving a kidney transplant between 2007 and 2016. Data were from the Canadian Hospitalization and Taxation Database (C-HAT), which includes hospital discharge records and income tax data. Eligible adults were aged 30 to 62 years; exclusions included repeat or multiorgan transplants, residents of Quebec or territories, and individuals with incomplete tax data or those in the top or bottom 1% of income earners. Data analyses were conducted between June 2024 to October 2025. Exposure: Kidney transplant. Main Outcome and Measures: The primary outcome was annual employment income, derived from tax records for 3 years before and after transplant. Employment income was defined as the combined total of employment income, self-employment income, and other employment income, and adjusted to 2023 Canadian dollars using the Bank of Canada Consumer Price Index. A linear mixed-effects model was used to evaluate changes in income over time. Results: The final cohort included 3230 individuals (mean [SD] age, 47 [8.4] years), of whom 1120 (34.7%) were female and 2630 (81.4%) were aged 30 to 55 years. Pretransplant, income declined by $4293 per year (95% CI, -$4726 to -$3861 per year; P < .001); posttransplant, income increased by $1006 per year (95% CI, $406 to $1605; P = .001). Conclusions and Relevance: In this cohort study of 3230 kidney transplant recipients, kidney transplant was associated with a reversal of declining employment income, indicating meaningful economic recovery. These findings highlight the broader socioeconomic value of transplantation and may inform policies that support patients during pretransplant vulnerability and facilitate successful return to work.