Impact of Solid Organ Transplant History on Outcomes in Head and Neck Microvascular Reconstruction.

OBJECTIVE: To evaluate short-term postoperative outcomes and long-term survival following head and neck free tissue transfer (FTT) in solid organ transplant (SOT) recipients compared with matched non-transplant patients. STUDY DESIGN: Retrospective matched cohort study. SETTING: Two tertiary academic centers and a national database (TriNetX). METHODS: Adult patients undergoing head and neck FTT were identified from prospectively maintained multi-institutional databases and TriNetX. SOT recipients were matched 1:1 with non-SOT controls using propensity score matching. Primary outcomes included 30-day postoperative mortality and complications. Secondary outcomes included long-term overall survival (OS) and disease-free survival (DFS). RESULTS: In the multi-institutional cohort (36 SOT recipients matched to 36 controls), surgical and flap complications were comparable, but SOT recipients had higher rates of deep vein thrombosis (DVT) and urinary tract infection (UTI). Thirty-day mortality was higher among SOT recipients (11.1% vs 0%); CCI-adjusted Firth regression showed borderline increased odds of early mortality (OR 10.74; 95% CI 0.97-1494.70; p = 0.054). The DVT association attenuated to non-significance after adjusting for prior DVT/PE (OR 2.18; p = 0.654); UTI remained associated (OR 24.36; p = 0.002). OS was lower in SOT recipients at 1, 3, and 5 years (HR 2.16; 95% CI 1.06-4.42); DFS did not differ. In the TriNetX cohort (136 matched pairs), 30-day outcomes were similar; OS remained reduced at 3 and 5 years (HR 1.48; 95% CI 1.04-2.11). CONCLUSION: While perioperative outcomes are comparable, SOT recipients face higher medical complications, worse long-term survival, and possible increased early mortality, underscoring the need for careful selection and vigilant follow-up.