Total Joint Arthroplasty in Transplant Recipients: In-Hospital Adverse Outcomes

Cavanaugh, Priscilla K.; Chen, Antonia F.; Rasouli, Mohammad R.; Post, Zachary D.; Orozco, Fabio; Ong, Alvin

doi:10.1016/j.arth.2014.11.037

Cited by 43 publications

(24 citation statements)

References 27 publications

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“…Fourteen studies, involving 15,481 solid organ transplant recipients of whom 14,427 (95%) were kidney transplants, and 7,807,705 non-transplanted patients satisfied the inclusion criteria (Table 1 : Summary of included studies). Non-emergent cardiac (5 studies) [ 5 , 18 , 20 , 24 , 27 ] and orthopaedic (5 studies) [ 16 , 17 , 19 , 22 , 23 ] surgery were the most commonly reported types of surgery. General surgical outcomes were reported in 3 studies [ 4 , 21 , 25 ].…”

Section: Resultsmentioning

confidence: 99%

“…Fatal outcomes were not reported by any of the studies in the vascular or urological/gynaecological surgical disciplines. A single study of orthopaedic procedures reported an adjusted mortality risk ratio but did not provide absolute event rates (3209 transplant recipients, OR 2.04, 95% CI 0.96-4.33, p = 0.06) [16]. Sensitivity analyses including only studies of kidney transplant populations revealed similar odds using unadjusted data (3 studies in general surgery, 5154 kidney transplant recipients, OR 2.22, 95% CI 1.25-3.96, I 2 85.6%, p for heterogeneity = 0.001, t = 1.9, Fig.…”

Section: Meta-analysis Of All-cause Mortalitymentioning

confidence: 99%

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Postoperative outcomes of kidney transplant recipients undergoing non-transplant-related elective surgery: a systematic review and meta-analysis

et al. 2020

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Background: Reliable estimates of the absolute and relative risks of postoperative complications in kidney transplant recipients undergoing elective surgery are needed to inform clinical practice. This systematic review and meta-analysis aimed to estimate the odds of both fatal and non-fatal postoperative outcomes in kidney transplant recipients following elective surgery compared to non-transplanted patients. Methods: Systematic searches were performed through Embase and MEDLINE databases to identify relevant studies from inception to January 2020. Risk of bias was assessed by the Newcastle Ottawa Scale and quality of evidence was summarised in accordance with GRADE methodology (grading of recommendations, assessment, development and evaluation). Random effects meta-analysis was performed to derive summary risk estimates of outcomes. Meta-regression and sensitivity analyses were performed to explore heterogeneity. Results: Fourteen studies involving 14,427 kidney transplant patients were eligible for inclusion. Kidney transplant recipients had increased odds of postoperative mortality; cardiac surgery (OR 2.2, 95%CI 1.9-2.5), general surgery (OR 2.2, 95% CI 1.3-4.0) compared to non-transplanted patients. The magnitude of the mortality odds was increased in the presence of diabetes mellitus. Acute kidney injury was the most frequently reported non-fatal complication whereby kidney transplant recipients had increased odds compared to their non-transplanted counterparts. The odds for acute kidney injury was highest following orthopaedic surgery (OR 15.3, 95% CI 3.9-59.4). However, there was no difference in the odds of stroke and pneumonia.

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Section: Resultsmentioning

confidence: 99%

Section: Meta-analysis Of All-cause Mortalitymentioning

confidence: 99%

Postoperative outcomes of kidney transplant recipients undergoing non-transplant-related elective surgery: a systematic review and meta-analysis

et al. 2020

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“…Timing was earlier in patients undergoing TKA for pulmonary embolism (day 3 [interquartile rage 2-6] versus 5 [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17], p \ 0.001) and deep vein thrombosis (day 5 [2-11] versus 13 [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22], p \ 0.001) ( Table 3). Some adverse events were associated with certain baseline characteristics.…”

Section: Resultsmentioning

confidence: 99%

What Is the Timing of General Health Adverse Events That Occur After Total Joint Arthroplasty?

Bohl

Ondeck

Basques

et al. 2017

Clinical Orthopaedics &Amp; Related Research

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“…Other risk factors likely contribute to this increased risk posttransplant, even when recipients undergo other surgical procedures. Cavanaugh et al [31] reported that for 3,209 recipients who underwent total joint arthroplasty between 1993 and 2011, the postoperative risk of DVT was two-fold higher than what it was for non-transplant patients. In addition to this, kidney transplant recipients had an increased risk of postsurgical in-hospital mortality (OR 2.0), acute kidney injury (OR 3.5), systemic infection (OR 2.9), wound infection (OR 2.0), and cardiac (OR 1.2) and respiratory complications (OR 1.3).…”

Section: Discussionmentioning

confidence: 99%

Venous Thromboembolism and the Risk of Death and Graft Loss in Kidney Transplant Recipients

Lam

Garg²,

Knoll³

et al. 2017

Am J Nephrol

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Background: The implications of venous thromboembolism (VTE) for morbidity and mortality in kidney transplant recipients are not well described. Methods: We conducted a retrospective study using linked healthcare databases in Ontario, Canada to determine the risk and complications of VTE in kidney transplant recipients from 2003 to 2013. We compared the incidence rate of VTE in recipients (n = 4,343) and a matched (1:4) sample of the general population (n = 17,372). For recipients with evidence of a VTE posttransplant, we compared adverse clinical outcomes (death, graft loss) to matched (1:2) recipients without evidence of a VTE posttransplant. Results: During a median follow-up of 5.2 years, 388 (8.9%) recipients developed a VTE compared to 254 (1.5%) in the matched general population (16.3 vs. 2.4 events per 1,000 person-years; hazard ratio [HR] 7.1, 95% CI 6.0-8.4; p < 0.0001). Recipients who experienced a posttransplant VTE had a higher risk of death (28.5 vs. 11.2%; HR 4.1, 95% CI 2.9-5.8; p < 0.0001) and death-censored graft loss (13.1 vs. 7.5%; HR 2.3, 95% CI 1.4-3.6; p = 0.0006) compared to matched recipients who did not experience a posttransplant VTE. Conclusions: Kidney transplant recipients have a sevenfold higher risk of VTE compared to the general population with VTE conferring an increased risk of death and graft loss.

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Total Joint Arthroplasty in Transplant Recipients: In-Hospital Adverse Outcomes

Cited by 43 publications

References 27 publications

Postoperative outcomes of kidney transplant recipients undergoing non-transplant-related elective surgery: a systematic review and meta-analysis

Postoperative outcomes of kidney transplant recipients undergoing non-transplant-related elective surgery: a systematic review and meta-analysis

What Is the Timing of General Health Adverse Events That Occur After Total Joint Arthroplasty?

Venous Thromboembolism and the Risk of Death and Graft Loss in Kidney Transplant Recipients

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