TY - JOUR
T1 - Risk Factors in Patients Who Had Prior Renal or Liver Transplant Undergoing Primary Total Knee Arthroplasty
AU - Mansour, Elie
AU - Boddu, Sayi P.
AU - Gill, Vikram S.
AU - Abu Jawdeh, Bassam G.
AU - McGary, Alyssa K.
AU - Clarke, Henry D
AU - Spangehl, Mark Joseph
AU - Abdel, Matthew P.
AU - Ledford, Cameron K.
AU - Bingham, Joshua S.
N1 - Publisher Copyright:
© 2023 Elsevier Inc.
PY - 2023
Y1 - 2023
N2 - Background: More solid organ transplant (SOT) patients are undergoing total knee arthroplasty (TKA). This study identifies risk factors for complications, implant survivorship, and mortality in TKA patients who had prior SOT. Methods: We identified 176 TKAs in patients who had prior SOT. Of these, 77 had a prior renal (RT), 77 had a prior liver (LT) transplant, and 22 had multiple prior transplants (MT). Median survival was estimated using Kaplan-Meier. Univariate analyses were assessed with mixed-effects logistic regressions for complications and Cox-regressions for mortality. Median follow-up was 63 months (range, 24 to 109). Results: At least one acute medical complication occurred in 25, 13, and 27% of cases with prior RT, LT, and MT, respectively (P =.12). None of the variables were significantly associated with acute medical complications. At least one surgical complication occurred in 14, 13 and 14% of cases with prior RT, LT, and MT, respectively (P = 1). Vitamin D supplementation (Odds Ratio [OR] = 0.38, P <.03) was associated with lower risk of surgical complications. Reoperation and revision rates were 5 and 3%, respectively. Older age at time of transplantation and greater level of serum creatinine at time of TKA were associated with lower risk (OR = 0.96, P =.01), and higher risk of reoperation (OR = 4.9, P =.01), respectively. Coronary artery disease was associated with higher mortality (Hazard Ratio = 2.35, P =.01). Conclusions: Vitamin D was associated with lower surgical complications, whereas a younger age at time of transplantation increased the risk of reoperation. Additionally, SOT patients with coronary artery disease demonstrated higher mortality after TKA.
AB - Background: More solid organ transplant (SOT) patients are undergoing total knee arthroplasty (TKA). This study identifies risk factors for complications, implant survivorship, and mortality in TKA patients who had prior SOT. Methods: We identified 176 TKAs in patients who had prior SOT. Of these, 77 had a prior renal (RT), 77 had a prior liver (LT) transplant, and 22 had multiple prior transplants (MT). Median survival was estimated using Kaplan-Meier. Univariate analyses were assessed with mixed-effects logistic regressions for complications and Cox-regressions for mortality. Median follow-up was 63 months (range, 24 to 109). Results: At least one acute medical complication occurred in 25, 13, and 27% of cases with prior RT, LT, and MT, respectively (P =.12). None of the variables were significantly associated with acute medical complications. At least one surgical complication occurred in 14, 13 and 14% of cases with prior RT, LT, and MT, respectively (P = 1). Vitamin D supplementation (Odds Ratio [OR] = 0.38, P <.03) was associated with lower risk of surgical complications. Reoperation and revision rates were 5 and 3%, respectively. Older age at time of transplantation and greater level of serum creatinine at time of TKA were associated with lower risk (OR = 0.96, P =.01), and higher risk of reoperation (OR = 4.9, P =.01), respectively. Coronary artery disease was associated with higher mortality (Hazard Ratio = 2.35, P =.01). Conclusions: Vitamin D was associated with lower surgical complications, whereas a younger age at time of transplantation increased the risk of reoperation. Additionally, SOT patients with coronary artery disease demonstrated higher mortality after TKA.
KW - complications
KW - liver transplant
KW - renal transplant
KW - risk factors
KW - survival
KW - total knee arthroplasty
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U2 - 10.1016/j.arth.2023.11.030
DO - 10.1016/j.arth.2023.11.030
M3 - Article
C2 - 38048964
AN - SCOPUS:85180613803
SN - 0883-5403
JO - Journal of Arthroplasty
JF - Journal of Arthroplasty
ER -