Abstract WP053: Mechanical Thrombectomy in Acute Ischemic Stroke Among Solid Organ Transplant Recipients: A Nationwide Analysis of Utilization and Outcomes(2016-2022)

Background: Solid organ transplant (SOT) recipients represent a medically complex cohort with a high burden of risk factors for acute ischemic stroke (AIS). However, national patterns of mechanical thrombectomy (MT) utilization and its associated outcomes in this population remain poorly defined. Objective: We sought to evaluate temporal trends in MT utilization for AIS and to determine the association of SOT status with in-hospital mortality following the procedure. Methods: We conducted a retrospective cohort study using the Nationwide Inpatient Sample from 2016–2022. Survey-weighted multivariable logistic regression models were used to compare the odds of receiving MT among all AIS patients and the odds of in-hospital mortality among MT recipients, stratifying by SOT status. Models were adjusted for a comprehensive set of patient- and hospital-level confounders. Results: The study cohort included an estimated 4.76 million AIS hospitalizations. MT utilization was significantly lower in SOT recipients compared to non-recipients (2.79% vs. 4.42%; p<0.001). In multivariable analysis, SOT status was independently associated with significantly lower odds of receiving MT (adjusted Odds Ratio [aOR] 0.585, 95% CI 0.474–0.721). Among the cohort of patients who underwent MT (n≈197,000), SOT was associated with a statistically non-significant increase in the odds of in-hospital mortality (aOR 1.57, 95% CI 0.92–2.68; p=0.10), with adjusted mortality rates of 15.2% and 10.4% for SOT and non-SOT patients, respectively. Conclusion: Nationally, patients with a history of solid organ transplantation who present with acute ischemic stroke are significantly less likely to receive mechanical thrombectomy. This disparity in care underscores a critical need to identify and address the barriers to optimal stroke reperfusion therapy in this vulnerable population.