Impact of Solid Organ Transplant on Postoperative Outcomes Following Lumbar Spine Fusion Surgery: A Propensity-Matched Retrospective Cohort Analysis

Abstract Background SOT recipients represent a complex and vulnerable population. The physiologic effects of chronic immunosuppression may predispose these patients to adverse postoperative events, yet large-scale analyses of lumbar spine fusion outcomes in this group remain limited. Methods Adults over 18 years of age who underwent LSF between 2015 and 2024 were identified through procedural coding the TriNetX database. Patients with a history of SOT, were matched 1:1 to non-transplant controls based on baseline demographics and comorbidities. Postoperative complications were evaluated using statistical tools integrated within the database. Results After 1:1 propensity score matching, each cohort included 408 patients. At 90 days, SOT patients had higher odds of wound dehiscence (OR 2.33, 95% CI 1.17–4.67), emergency department utilization (OR 1.86, 95% CI 1.26–2.74), and overall medical complications (OR 1.98, 95% CI 1.18–3.30) compared to matched non-SOT controls. At 1-year, transplant recipients had increased rates of reoperation (OR 2.2, CI 1.055–4.59) and pseudoarthrosis (OR 1.76, CI 1.38–2.58). Conclusions Increased morbidity associated with SOT was reflected by the higher risk for medical complications and wound complications in the short term. Long-term physiologic changes secondary to long-term immunosuppressive therapy were also represented by long-term surgical complications. Our findings highlight a need for a tailored, interdisciplinary approach for surgical planning and postoperative care for this high-risk patient population. Level of Evidence IV