Introduction

Patients who received solid organ transplants (SOT) (heart, lung, liver and kidney) are living longer healthier lives due to advancements in immunosuppressive agents. Adverse effects of continued immunosuppressive medications are increased risk of infection and decreased bone mineral density (BMD) increasing risk of fractures. Little is known about how patients with SOT tolerate orthopaedic procedures. We sought to characterize indications and outcomes of shoulder arthroplasty among patients with SOT at a tertiary care center.

Methods

We identified all patients with a history of a solid organ transplantation (Heart, Lung, Liver, and Kidney) who underwent shoulder surgery between 2014 and 2024 at Michigan Medicine. Demographic, operative and post-operative details were collected. Descriptive statistics were used to characterize the patient outcomes.

Results

A total of 26 patients underwent shoulder surgery following solid organ transplantation, accounting for 32 surgical procedures. Transplanted organs included kidney (n=16, 55%), heart (n=8, 28%), lung (n=4, 14%), and liver (n=1, 3%). The median age at surgery was 67 years (range, 49–79 years).

Procedures performed included reverse total shoulder arthroplasty (rTSA, n=16, 50%), rotator cuff repair (n=10, 31%), total shoulder arthroplasty (TSA, n=5, 16%), and arthroscopic debridement (n=1, 3%). Immunosuppressive therapy was continued perioperatively in all cases. Five patients (16%) received additional perioperative antibiotics.

Perioperative complications were uncommon, with one case of pneumonia (3%). At 6 months, one patient experienced dislocation which required revision (3%). At 12 months, two patients required revision for hardware-related discomfort (6%).

The median time from transplant to shoulder surgery was 9 years (range, 8 months–40 years).

Conclusions

At our tertiary care center, shoulder surgery was associated with high rates of procedural success and low rates of post-operative complications over 12 months. While this study was not powered for statistical significance due to diversity in surgical interventions and small sample size, it is encouraging to see a positive trend in outcomes. This highlights the need for further investigation with a larger multicenter study to quantify risk and appropriate time interval to surgery following SOT.

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