Medical Student Icahn School of Medicine at Mount Sinai New York, New York, United States
Introduction: The prolonged longevity of organ transplant recipients coupled with the expected rise in spine surgery utilization highlights a need for further studies on spine surgery patients who have previously undergone organ transplantation. Moreover, the anesthesiologic considerations, immunology profiles, drug interactions, and potential organ dysfunction make patients with transplant history a unique yet relatively unstudied population of spine surgery patients. Although multiple case reports and case series have previously been published on this topic, there has not been a comprehensive review of the literature surrounding this topic. The objective of this study is to investigate the perioperative management and outcomes of patients with a prior history of successful transplantation undergoing spine surgery.
Methods: Three databases, Medline, Embase, and Cochrane Central, were searched in July 2021. Search terms included various organ transplant types as well as an exhaustive list of keywords for various forms of spine surgery. Meta-analysis was then performed on extracted data.
Results: In total, 45 studies were included, consisting of 34 case reports, three cohort analyses, and eight retrospective analyses (n = 9778 patients). The mean one-year mortality rate from retrospective analyses was 4.6±1.93%, while the prevalence of perioperative complication was 24%. Cohort studies demonstrated an 8.5±12.03% 30-day readmission rate. The most frequent organs transplanted included kidney (36.1%), liver (30.6%), bone marrow (13.9%), lung (8.3%), and heart (5.6%). The mean interval between transplant and spine surgery was 32.4±36.8 months. Within the case reports, the most common procedure was laminectomy (38.9%) and mortality after spine surgery was 11.4%.
Conclusion : This is the first systematic scoping review examining this medically complex group of transplant patients with subsequent unrelated spine surgery. Clinical decision-making regarding immunosuppressant use, infection prevention, and reducing mortality may benefit from risk modeling by a multidisciplinary team of physicians combined with close postoperative follow-up.
