Outcomes of microvascular head and neck reconstruction in solid organ transplant patients: A single institution experience and meta-analysis.

Abstract

Solid organ transplant recipients are at increased risk of developing head and neck squamous cell carcinoma (HNSCC). These patients often require free flap reconstruction; however, data on outcomes in this immunosuppressed population remain limited and formal management guidelines are lacking. We conducted a systematic review and pooled proportions meta-analysis, and a retrospective institutional database review, to compare outcomes of head and neck free flap reconstruction in transplant versus non-transplant patients. Cancer-related mortality and time from surgery to death were also assessed. The systematic review yielded four eligible studies. Kidney transplantation and anterolateral thigh flaps were the most common. Prednisone was the predominant immunosuppressant. The pooled flap success rate was 97%, with recipient and donor site complication rates of 21% and 16%, respectively. Our database had 14 transplant patients who underwent head and neck reconstruction for oral SCC (n = 12) or osteoradionecrosis (n = 2). Tacrolimus was the most common immunosuppressant. Recipient/donor site dehiscence, skin graft loss, and reoperation were significantly higher in transplant patients. Rates of infection, salivary leak, hardware exposure, or hematoma were similar. Overall mortality was significantly higher in transplant patients (64% vs. 23%; p < 0.001), although the 2-year mortality did not differ on Kaplan-Meier analysis. Although free flap survival in transplant patients is comparable to non-transplant patients, postoperative complication rates are higher. Given their distinct risk profile and poorer prognosis, transplant patients with HNSCC may benefit from dedicated treatment guidelines.