Orthopedic Surgery in Liver Transplant Recipients: Does Surgical Urgency Influence Post Operative Morbidity

Document Type

Conference Proceeding

Publication Date

8-1-2025

Publication Title

Am J Transplant

Abstract

Purpose: Despite chronic immunosuppression, liver transplant recipients often require surgical interventions, with a growing demand for orthopedic procedures in this population. These surgeries present significant perioperative challenges, requiring a balance between maintaining immunosuppression and minimizing post-operative complications. However, the impact of surgical urgency on post-operative outcomes remains unclear. This study evaluates post-operative complications in liver transplant recipients undergoing elective versus emergent orthopedic surgeries and examines whether immunosuppressive regimens influence outcomes. Methods: A retrospective cohort study was conducted using SlicerDicer to identify liver transplant recipients who underwent orthopedic surgeries between 2013 and 2022. Patients were categorized based on surgical urgency as either elective or emergent. Collected data included demographics, type of surgery, and immunosuppressive regimen. Outcomes assessed included infection, transaminitis, acute kidney injury (AKI), and hospital readmission within one year post-operatively. Differences in outcomes among various immunosuppressive regimens were also examined. A descriptive analysis was performed to identify trends in post-operative complications based on surgical urgency and immunosuppressive regimen. Results: A total of 87 patients were included, with a mean age of 67.5 years and a mean transplant-to-surgery interval of 87 months. The majority were male (59%, n=51) and White (82%, n=71), with smaller proportions of African American (16%, n=14) and other racial backgrounds (2%, n=2). Of these, 69 patients (79.3%) underwent elective orthopedic procedures, while 18 patients (20.7%) underwent emergent surgeries. Post-operatively, infection occurred in 7.2% of elective cases and 16.7% of emergent cases, transaminitis in 7.2% of elective cases and 11.1% of emergent cases, and AKI in 17.4% of elective cases and 16.7% of emergent cases. Hospital readmission within one year was observed in 36.2% of elective cases and 50.0% of emergent cases. These findings suggest a trend toward increased post-operative complications in patients undergoing emergent orthopedic surgery, particularly infections and transaminitis. Additionally, no significant differences in complication trends were observed among different immunosuppressive regimens. Conclusions: Orthopedic surgery in liver transplant recipients carries a risk of post-operative complications, with emergent procedures showing a trend toward systemic complications. While no differences were observed between immunosuppressive regimens, these findings highlight the need for careful perioperative management, particularly in emergent cases. Further studies with larger sample sizes are warranted to better define perioperative risks and guide clinical decision-making in this patient population. CITATION INFORMATION: Saleem A., Alomari A., Samad M., Ilyas O., Khaliq I., Abusuliman M., Chaudhary A., Omeish H., Faisal M., Dababneh Y., Affas S., Jafri S. Orthopedic Surgery in Liver Transplant Recipients: Does Surgical Urgency Influence Post Operative Morbidity AJT, Volume 25, Issue 8 Supplement 1 DISCLOSURES: A. Saleem: None.

Volume

25

Issue

8

First Page

S489

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