Complications of total hip and knee arthroplasty in solid organ transplant patients: a systematic review and meta-analysis

Complications of total hip and knee arthroplasty in solid organ transplant patients: a systematic review and meta-analysis | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Complications of total hip and knee arthroplasty in solid organ transplant patients: a systematic review and meta-analysis Dimitris Challoumas, Rohan Ramasubbu, Elliot Rooney, Angus Paterson, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7185982/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 9 You are reading this latest preprint version Abstract Background: The aim of this systematic review and meta-analysis was to quantify risks of complications associated with total hip and knee arthroplasty (THA, TKA) in patients with solid organ transplants (SOT) compared to the general population. Methods : The study was pre-registered on PROSPERO (CRD42023399043). Literature searches were performed looking for comparative studies reporting postoperative complication data of THA or TKA in patients with kidney, liver, pancreas, heart or lung transplants versus controls. Outcomes of interest included incidence of blood transfusion, periprosthetic joint infection (PJI), periprosthetic fracture, deep venous thrombosis (DVT), pulmonary embolism (PE), mortality, hospital re-admission and all-cause revision. The Newcastle Ottawa scale was used to assess study quality and the GRADE for certainty of evidence. Results : A total of 13 studies participated in meta-analyses (10 in THA, 3 in TKA). Compared to controls, SOT patients (mixed data from all transplant types) had a significantly higher incidence of blood transfusion [THA OR 1.57 (1.36–1.80), TKA OR 1.37 (1.15–1.63)], PJI [THA OR 1.78 (1.01–3.12), TKA 3.11 (1.16–8.35)], DVT [THA OR 1.32 (1.04–1.66), TKA OR 1.56 (1.36–1.78)], and all-cause revision [only TKA OR 1.37 (1.15-1.63)]. THA in kidney transplant patients was associated with higher early mortality [OR 2.12 (1.38-3.25)] and 30-day re-admission [OR 1.62 (1.31-2.00)] compared to the general population. SOT were not associated with a higher incidence of post-operative PE after either THA or TKA [OR 0.94 (0.66-1.34), OR 0.89 (0.55-1.43), respectively]. The incidence of THA dislocation in mixed analyses with all SOT types was not statistically significant despite the unfavourable OR [1.62 (0.94-2.78)] but it was in the kindey and heart transplant subgroup analyses (OR 1.41 (1.16-1.73), OR 2.17 (1.47-3.20), respectively. The incidence of periprosthetic fracture was not higher in SOT patients compared to controls in those undergoing a THA [OR 1.07 (0.84-1.36)], but it was after a TKA [OR 1.79 (1.36-2.36)]. Conclusion: THA and TKA is associated with an unfavourable complication profile in SOT patients compared to the general population. Decisions for or against arthroplasty surgery should be made on an individual basis with a multidisciplinary approach. joint replacement renal transplant revision infection complications 1 INRODUCTION Longevity of patients with solid organ transplants (SOT; kidney, liver, pancreas, heart and lung) is continuously increasing thanks to improvements in perioperative management and immunosuppressive treatment[ 1 , 2 ]. In addition to the patients with SOT who go on to develop arthritis at incidences similar to the general population, the immunosuppressive regimes can be responsible for avascular necrosis, usually of the femoral head, which has been estimated at an overall rate of 5% in this group of patients[ 3 , 4 ]. As a result, transplant patients have approximately a fivefold increased incidence of needing a joint replacement compared to the general population[ 5 ]. Previous literature has reported significant improvements in clinical outcomes in SOT patients undergoing total hip arthroplasty (THA) or total knee arthroplasty (TKA)[ 6 ]. However, there remains a question whether these benefits outweigh the risks, which are primarily driven by the medical complexity of this group of patients and the requirement of lifelong immunosuppression. Decisions on whether to proceed to total joint arthroplasty surgery in SOT patients should be made on a multidisciplinary basis, involving all implicated medical professionals (surgeon, anaesthetist, internal medicine physician) and, especially, the patients themselves, after careful consideration of the patient as an individual and the impact of the arthritis on their quality of life. Current data on complication profiles of THA and TKA in SOT patients are mostly based on retrospective reviews of database registries and they can be challenging to interpret separately due to the several types of complication outcomes reported and subgroup data for each transplant type and also arthroplasty procedure (THA vs TKA). Our aim was to systematically identify, present and summarise all the relevant existing evidence and quantify the risks of complications, with the ultimate objective to inform implicate healthcare professionals and patients and guide the informed consent process. 2 MATERIALS AND METHODS This systematic review and meta-analysis was prospectively registered on PROSPERO (CRD42023399043) and was conducted as per PRISMA guidance[ 7 ]. 2.1 Eligibility criteria 2.1.1 Types of studies Observational studies that included a control group were eligible for inclusion. Only studies published in English were screened for inclusion. 2.1.2 Exposure—control Studies of patients with any type of SOT undergoing a primary THA or TKA were eligible if they also included a matched control population without SOT. The present study excluded trials with (1) revision THA or TKA, (2) arthroplasty of joints other than hip or knee, (3) partial hip (hemiarthroplasty) or knee (unicompartmental) arthroplasty, (4) studies that only assessed outcomes in SOT patients without a matched control (i.e., case series), (5) studies with patients with non-solid organ transplants (e.g. bone marrow). 2.1.3 Types of outcome measures Incidence of blood transfusion, periprosthetic joint infection (PJI), dislocation (THA only), venous thromboembolism (deep venous thrombosis and pulmonary embolism), mortality and all-cause revision. 2.2 Literature search Search strategies were developed in ‘all fields’ with the following search terms: a) ‘(solid organ transplant OR kidney transplant OR renal transplant OR liver transplant OR heart transplant OR lung transplant OR pancreas transplant) AND (arthroplasty OR joint replacement OR joint arthroplasty OR knee arthroplasty OR hip arthroplasty OR knee replacement OR hip replacement)’. The following databases were screened for published and unpublished trials from inception to March 2025 by two authors: Medline and Embase (via Ovid), Cochrane central and OpenGrey.eu. For unpublished or ongoing studies, we searched the WHO International Clinical Trials Registry Platform ( http://apps.who.int/trialsearch/ ) Clinical Trials.gov, The European Union Clinical Trials Register and the ISRCTN registry. The reference and citation lists of all eligible studies were screened for further eligible trials. The PRISMA flowchart is illustrated in the Supplementary Material. A total of 533 studies were identified after removal of duplicates and their titles were screened. After removal of non-eligible study types, the abstracts and full texts of the remaining studies were screened for inclusion by two authors independently. The PRISMA flow diagram (Supplementary material) summarises the article selection process. 2.3 Data extraction Patient and intervention characteristics, outcome measures and follow up duration were extracted from individual trials and recorded in Microsoft Word version 16.43 (Microsoft corp) by two authors separately in a previously constructed standardised data collection form. For missing data, attempts were made to contact the corresponding authors of studies published in the last 5 years. 2.3.1 Data handling—synthesis of results Studies assessing the same outcome measures in patients with SOT and matched controls were pooled in pairwise meta-analyses in the absence of significant clinical heterogeneity (similar populations, follow up time points and interventions). Data were pooled separately for each SOT type (kidney, liver, heart, lung, pancreas) where sufficient data available, and also for all SOT types combined. This was done for TKA and THA separately and not for combined THA/TKA outcomes as there were no outcomes for which two or more mixed THA/TKA studies reported data, therefore pooling could not be performed for mixed THA/TKA data. ratios (ORs) with 95% confidence interval (CI) were used for all outcomes. 2.4 Risk of bias and strength of evidence assessment The Newcastle-Ottawa Scale (NOS) for cohort studies was used to assess risk of bias (RoB)[ 8 ]. The thresholds recommended within the tool for converting NOS scores to Agency for Healthcare Research and Quality (AHRQ) standards (good, fair and poor quality) were used. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) tool was used to appraise the certainty (strength) of evidence[ 9 ]. For pairwise meta-analyses, certainty of evidence was assessed based on five domains: overall RoB, imprecision, inconsistency, indirectness and other confounding factors (including publication bias). The result of each comparison of interventions was assigned one of high, moderate, low or very low certainty of evidence. The certainty of evidence started from ‘high’, as the included studies were diagnostic rather than designed to assess interventions and was downgraded for one step each time when any one of the five domains raised concerns. The certainty of evidence was upgraded when the magnitude of effect was very large and at statistical significance and when the confidence intervals were very narrow (downgraded when very wide). When the overall results were based on data from one study only, the certainty of evidence started at “moderate”. For the combined SOT results, the certainty of evidence was always downgraded by one level for indirectness (clinical heterogeneity, different transplant types). For both RoB and certainty of evidence assessment, studies were assessed by two authors separately and controversies were resolved with involvement of the senior author. 2.5 Statistical analysis The Review Manager V.5 (RevMan) software was used to calculate pooled ORs and generate forest plots for pairwise meta-analyses and their accompanying heterogeneity tests (Chi 2 and I 2 ). Potential publication bias was not assessed as no pairwise meta-analyses included more than 10 studies. Expecting wide-range variability in studies’ settings, a random-effects model was employed in all meta-analyses. 3 RESULTS A total of 17 studies were found to be eligible and were included[ 1 , 10 – 25 ]. Four studies did not participate in meta-analyses as they reported mixed results of THA and TKA in SOT patients vs controls[ 1 , 11 , 12 , 17 ]. From the 13 studies that contributed to meta-analyses, 10 were on THA and 3 on TKA. Their characteristics are shown in Table 1 . Table 1 Study characteristics table First author et al. (year) Procedure (THA vs TKA) SOT Type (kidney, liver, etc) Population n = X, mean age = X in each group Exposure vs Control matched for? Outcomes assessed Follow-up period for revision and PJI Lim et al. (2021) THA Kidney Control group n = 72 with 94 THA (mean age 45 years) SOT group n = 30 patients with 45 THA (mean age 44 yes) Sex, BMI, age, AVN, Duration of follow-up Pre and post op Harris Hip score Radiographic: wear, loosening, ectopic ossification Complications: Infection, dislocation, PPF, DVT, wound issues, nerve palsy, revision Minimum 2 year follow-up. Mean follow-up 7.2 years for both groups. Mcleery et al. (2010) TKA Kidney Control group n = 55570 SOT group n = 25 (mean ages not stated) Not matched Early ( 90 days) Early ( 365 days) all-cause revision Not specified. Late revision was > 365 days. Agarwal et al. (2021) THA Kidney, heart, lung, liver, pancreas Control group n = 6196 (mean age 60–70 years) SOT group n = 3103 (mean age 60–70 years) Age, gender, Charlson Comorbidity Index, obesity PJI, DVT, PT, mortality, blood transfusion, all-cause revision Minimum 2 years follow-up Navale et al. (2017) THA Kidney, heart, lung, liver, pancreas Control group population 2,772,943 (mean age 60–70 years) SOT group n = 7558 (mean age 50–60 years) Age, sex, race, insurance, hospital region, hospital location and bed size, teaching hospital PJI, dislocation, DVT, PT, blood transfusion NA Klement et al. (2016) TKA Kidney, liver, lung, heart and pancreas Control group n = 1685295 (mean age 65–69 yars) SOT group n = 3334 (mean age < 65 years) Not matched Medical and Surgical Outcomes at 30, 90 and “overall” Medical – MI, HF, Arrythmia with and without AF, respiratory failure, DVT, PE, CVA, PNA, sepsis/SIRS, acute renal failure, anaemia, blood transfusion Surgical – MUA, Periproshetic infection, PPF, TKA revision, arthrotomy, patellar complications, extensor mechanism rupture Minimum 2 years follow-up Douglas et al. (2021) THA Liver Control group n = 10246 (mean age 60 years) SOT group n = 513 (mean age 60 years) Age, gender, Charlson Comorbidity Index, obesity and diabetes LOS, readmissions, blood transfusion, MI, DVT, PE, pneumonia, resp failure, dislocation, mechanical complications (PPF, aspectic loosening, Periprosthetic oseolysis) 90 days, 1 year, 2 years and 5 years Quinlan et al. (2022) THA Heart, lung, kidney, pancreas, liver Control group n = 4980 (mean age < 64 years) SOT group n = 996 (mean age < 64 years) Age, gender, tobacco use, Diabetes Death, Hospital admission 30 and 90d), ER visit (30 and 90d), infection, all-cause revision, aseptic revision, dislocation 1 year Malkani et al. (2020) THA Kidney SOT group n = 94 (mean age not reported) Control group n = 54,902 (mean age not reported) Not matched VTE, PJI, Dislocation, readmission, mortality. All were over 90d, 0.5y, 1y, 2y & 5y. 5 years Tornero et al. (2015) THA Kidney SOT group n = 15 (mean age 53.8 years) Control group n = 74 (mean age 68.0 years) Not matched Blood transfusion, LOS, early postopeative complications (early PJI, dislocation, systemic infections, DVT & other complications), rate of revision (aseptic loosening, PJI or fracture) and overall prosthesis survival (1, 2, 5 & 10 years) 10y Klika et al. (2015) TKA SOT (not specified) Control group n = 5,864,317 (mean age 66.8 years) SOT group n = 6,104 (mean age 60.8 years) Patient characteristics (sex, age, race, household income, primary payer source) Hospital characteristics (region, bed size, location, surgeon volume, hospital volume) and comorbidities. LOS, costs per admission, and perioperative complications and adverse events [Medical complications, need for blood transfusion and surgical complications (either related to implant, eg; dislocation and fractures, or general, eg; wound related, DVT/PE,…)]. not specified -infection rates are limited to the perioperative hospital stay until discharge. Klement et al. (2017) THA Kidney, liver, lung, heart & pancreas Control group n = 771,498 (> 65% 65-79y age range) SOT group n = 3,180 [Kidney n = 2,321, Liver n = 561, Lung n = 196, Heart n = 428, Pancreas n = 149] (> 60% were less than 60yrs of age). No mean age was provided. Not matched A list of medical complications by 30 days post op, and surgical complications (PJI, dislocation, fracture, osteolysis + poly wear, mechanical complications, revision and arthrotomy/I&D. Minimum 2 years Oya et al. (2021) THA Liver Control group n = 27 (mean age 55.8 years) SOT group n = 7 with 9 THA (mean age 58.4 years) Not matched FBC, UE’s, LFT’s, opera- tive time, intraoperative blood loss, incidence of perioperative complications, and Harris Hip Score (HHS) Mean 46.3 months (Range 24–60 months) Varatharaj 2022 THA Not listed Control group n = 367894 (mean age 66 years) SOT group n = 813 (mean age 61 years) Not matched Medical and Surgical Outcomes (elective procedure, dislocation, mortality/death, hematoma, wound disruption, infection, anemia, acute renal failure, hypotension, pulmonary embolism, myocardial infarction, pneumonia, blood transfusions, intra-operative complications, deep venous thrombosis, stroke, peri-prosthetic fractures, prosthetic hip dislocations, prosthetic loosening, length of stay, and health care- related expenditure). Not reported Follow-up duration ranged from 1 to 10 years; 4 studies had a minimum follow-up of 2 years in all included patients. Matching of SOT patients with controls was performed in 7 studies. Details on perioperative immunosuppressive therapy were not provided by most studies and we assume there was significant heterogeneity in this both across and within studies. There was also poor reporting and, consequently, assumed high heterogeneity with regard to type of arthroplasty implants and use of cement. Study quality was found to be ‘good’ in 15 studies and ‘poor’ in two studies (Table 2 ). The certainty of evidence was therefore not downgraded for high risk of bias for any of the results. Table 2 Study quality assessment with Newcastle-Ottawa tool. Selection Comparability Outcome Overall Study 1 2 3 4 1 1 2 3 Lim 2021 ✓ ✓ ✓ ✓ ✓ ✓ ✘ ✓ ✓ Good quality Mcleery 2010 ✘ ✘ ✓ ✓ ✘✘ ✘ ✘ ✘ Poor quality Agarwal 2021 ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ Good quality Navale 2017 ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✘ ✓ Good quality Klement 2016 ✓ ✓ ✓ ✓ ✘ ✓ ✓ ✓ ✘ Good quality Ahmed 2023 ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ Good quality Douglas 2021 ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✘ Good Quality Quinlan 2022 ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✘ ✓ Good Quality Malkani et al. (2020) ✓ ✓ ✓ ✓ ✘ ✓ ✓ ✓ ✘ Good quality Tornero et al (2015) ✓ ✓ ✓ ✓ ✘ ✓ ✓ ✓ ✘ Good quality Kilka et al. (2015) ✓ ✓ ✓ ✓ ✓✓ ✓ ✘ ✓ Good quality Klement et al. (2017) ✓ ✓ ✓ ✓ ✘ ✓ ✓ ✓ ✓ Good quality Kuo 2018 ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ Good quality Brown 2020 ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ Good quality Oya 2021 ✘ ✓ ✓ ✓ ✓ ✘ ✓ ✓ ✘ Good quality Varatharaj 2022 ✓ ✓ ✓ ✓ ✘✘ ✓ ✓ ✓ Poor quality Dodin 2021 ✓ ✓ ✓ ✓ ✓ ✘ ✓ ✓ ✓ Good quality Table 3 provides a summary of the results of each study per outcome measure and the results of pooling, where performed, with the accompanying certainty of evidence for each pooled result. In the text below, we present the results of the meta-analyses of all SOT types analysed together and those specific SOT types with statistically significant results. All other results are summarised in Table 3 , with their accompanying certainty of evidence. Table 3 Main results. Statistical significance is denoted by confidence intervals that do not include “1”. Transplant type First author (year) PJI PP# 30day re-admission Dislocation (THA only) DVT PE Mortality Blood transfusion All cause revision Notes THA only Kidney Number of studies (total n SOT/Control) 4 (2478/826572) 2 (2384/771670) - 4 (2478/826572) 2 (2384/771670) 1 (2321/771498) 1 (8669 /54934) 2 (2339/771574) 2 (2346/1740865) Mean OR (95% CI) 1.50 (0.65, 3.49) 1.09 (0.81, 1.48) - 1.41 (1.16, 1.73) 1.60 (1.30, 1.97) 0.90 (0.57, 1.43) 2.8 (1.8, 4.2) 2.39 (0.63, 9.00) 1.30 (1.05, 1.61) I2 32% 0% - 0% 0% - - 83% 0% Certainty of Evidence Moderate ⊕⊕⊕∅ High ⊕⊕⊕⊕ - High ⊕⊕⊕⊕ High ⊕⊕⊕⊕ Moderate ⊕⊕⊕∅ Moderate ⊕⊕⊕∅ Low ⊕⊕∅∅ High ⊕⊕⊕⊕ Liver Number of studies (total n SOT/Control) 2 (1074/19961) 2 (570/771525) - 2 (1083/781771) 2 (1083/781771) 3 (1083/781771) - 2 (1074/781744) 2 (1074/781744) Mean OR (95% CI) 1.41 (0.94, 2.12) 0.54 (0.23, 1.27) - 1.09 (0.76, 1.56) 1.25 (0.76, 2.05) 0.77 (0.39, 1.52) - 1.51 (1.28, 1.77) 0.72 (0.48, 1.07) I2 14% 0% - 0% 43% 0% - 0% 0% Certainty of Evidence Moderate ⊕⊕⊕∅ Moderate ⊕⊕⊕∅ - Moderate ⊕⊕⊕∅ Moderate ⊕⊕⊕∅ Moderate ⊕⊕⊕∅ - High ⊕⊕⊕⊕ High ⊕⊕⊕⊕ Lung Number of studies (total n SOT/Control) 1 (196/771498) 1 (196/771498) - 1 (196/771498) 1 (196/771498) 1 (196/771498) - 1 (196/771498) 1 (196/771498) Mean OR (95% CI) 0.99 (0.41, 2.41) 1.52 (0.63, 3.70) - 0.84 (0.35, 2.05) 1.03 (0.42, 2.49) 3.02 (1.24, 7.34) - 1.71 (1.29, 2.26) 0.55 (0.22, 1.33) I2 - - - - - - - - Certainty of Evidence Low ⊕⊕∅∅ Low ⊕⊕∅∅ - Low ⊕⊕∅∅ Low ⊕⊕∅∅ Moderate ⊕⊕⊕∅ - Moderate ⊕⊕⊕∅ Low ⊕⊕∅∅ Heart Number of studies (total n SOT/Control) 1 (428/771498) 1 (428/771498) - 1 (428/771498) 1 (428/771498) 1 (428/771498) - 1 (428/771498) 1 (428/771498) Mean OR (95% CI) 1.86 (1.19, 2.91) 0.69 (0.28, 1.66) - 2.17 (1.47, 3.20) 2.33 (1.54, 3.51) 1.36 (0.56, 3.29) - 1.25 (1.03, 1.52) 1.13 (0.74, 1.74) I2 - - - - - - - - - Certainty of Evidence Moderate ⊕⊕⊕∅ Low ⊕⊕∅∅ - Moderate ⊕⊕⊕∅ Moderate ⊕⊕⊕∅ Low ⊕⊕∅∅ - Moderate ⊕⊕⊕∅ Low ⊕⊕∅∅ Pancreas Number of studies (total n SOT/Control) 1 (149/771498) 1 (149/771492) - 1 (149/771492) 1 (149/771492) 1 (149/771498) - 1 (149/771492) 1 (149/771492) Mean OR (95% CI) 1.32 (0.54, 3.21) 2.02 (0.83, 4.93) - 1.12 (0.46, 2.73) 1.36 (0.56, 3.32) 0.39 (0.02, 6.19) - 1.02 (0.72, 1.43) 0.73 (0.30, 1.77) I2 - - - - - - - - - Certainty of Evidence Low ⊕⊕∅∅ Low ⊕⊕∅∅ - Low ⊕⊕∅∅ Low ⊕⊕∅∅ Low ⊕⊕∅∅ - Low ⊕⊕∅∅ Low ⊕⊕∅∅ All transplant types combined Number of studies (total n SOT/Control) 8 (16320/2988831) 4 (4065/1139591) 2 (1509/15226) 8 (13226/1492664) 7 (15329/3928976) 6 (15176/3928804) 2 (4912/379070) 6 (15185/3928853) 6 (7436/837748) Mean OR (95% CI) 1.78 (1.01, 3.12) 1.07 (0.84, 1.36) 1.62 (1.31, 2.00) 1.62 (0.94, 2.78) 1.32 (1.04, 1.66) 0.94 (0.66, 1.34) 2.12 (1.38, 3.25) 1.57 (1.36, 1.80) 0.84 (0.58, 1.20) I2 93% 0% 0% 93% 41% 43% 0% 81% 68% Certainty of Evidence Moderate ⊕⊕⊕∅ Moderate ⊕⊕⊕∅ Moderate ⊕⊕⊕∅ V. Low ⊕∅∅∅ Moderate ⊕⊕⊕∅ Moderate ⊕⊕⊕∅ Moderate ⊕⊕⊕∅ V. Low ⊕∅∅∅ Low ⊕⊕∅∅ TKA only Kidney Number of studies (total n SOT/Control) 2 (2346/1740865) 1 (2321/1685295) - - 1 (2321/1685295) 1 (2321/1685295) 2 (6082/7549612) 1 (2321/1685295) Mean OR (95% CI) 3.18 (1.26, 7.99) 1.61 (1.14, 2.29) - - 1.57 (1.30, 1.89) 0.59 (0.38, 0.93) 1.42 (1.33, 1.51) 1.29 (1.04, 1.60) I2 68% - - - - - 0% Certainty of Evidence Moderate ⊕⊕⊕∅ Moderate ⊕⊕⊕∅ - - Moderate ⊕⊕⊕∅ Moderate ⊕⊕⊕∅ High ⊕⊕⊕⊕ Moderate ⊕⊕⊕∅ Liver Number of studies (total n SOT/Control) 1 (772/1685295) 1 (772/1685295) - - 1 (772/1685295) 1 (772/1685295) 2 (2149/7549612) 1 (772/1685295) Mean OR (95% CI) 2.31 (1.71, 3.11) 0.45 (0.03, 7.15) - - 1.58 (1.15, 2.19) 0.05 (0.00, 0.75) 1.76 (1.34, 2.31) 1.54 (1.09, 2.18) I2 - - - - - - 87% Certainty of Evidence Moderate ⊕⊕⊕∅ Low ⊕⊕∅∅ - - Low ⊕⊕∅∅ Low ⊕⊕∅∅ Moderate ⊕⊕⊕∅ Moderate ⊕⊕⊕∅ Lung Number of studies (total n SOT/Control) 1 (129/1685295) 1 (129/1685295) - - 1 (129/1685295) 1 (129/1685295) 1 (129/1685295) 1 (129/1685295) Mean OR (95% CI) 0.14 (0.01, 2.26) 0.45 (0.03, 7.15) - - 0.11 (0.01, 1.85) 0.28 (0.02, 4.47) 1.47 (1.06, 2.03) 0.13 (0.01, 2.08) I2 - - - - - - Certainty of Evidence Low ⊕⊕∅∅ Low ⊕⊕∅∅ - Low ⊕⊕∅∅ Low ⊕⊕∅∅ Low ⊕⊕∅∅ Low ⊕⊕∅∅ Heart Number of studies (total n SOT/Control) 1 (412/1685295) 1 (412/1685295) - - 1 (412/1685295) 1 (412/1685295) 1 (412/1685295) 1 (412/1685295) Mean OR (95% CI) 2.16 (1.42, 3.28) 0.14 (0.01, 2.24) - - 1.68 (1.09, 2.58) 0.09 (0.01, 1.40) 1.19 (0.96, 1.49) 0.04 (0.00, 0.65) I2 - - - - - - - - Certainty of Evidence Moderate ⊕⊕⊕∅ Low ⊕⊕∅∅ - - Low ⊕⊕∅∅ Low ⊕⊕∅∅ Moderate ⊕⊕⊕∅ Low ⊕⊕∅∅ Pancreas Number of studies (total n SOT/Control) 1 (167/1685295) 1 (167/1685295) - - 1 (167/1685295) 1 (167/1685295) 1 (167/1685295) 1 (167/1685295) Mean OR (95% CI) 0.11 (0.01, 1.75) 2.12 (0.13, 34.05) - - 2.10 (1.14, 3.87) 0.21 (0.01, 3.45) 1.47 (1.06, 2.03) 0.10 (0.01, 1.60) I2 - - - - - - Certainty of Evidence Low ⊕⊕∅∅ Low ⊕⊕∅∅ - - Moderate ⊕⊕⊕∅ Low ⊕⊕∅∅ Moderate ⊕⊕⊕∅ Low ⊕⊕∅∅ All transplant types combined Number of studies (total n SOT/Control) 2 (3359/1740865) 1 (3334/1685295) - - 2 (9438/7549612) 2 (9438/7549612) 2 (9438/7549612) 2 (3359/1740865) Mean OR (95% CI) 3.11 (1.16, 8.35) 1.79 (1.36, 2.36) - - 1.56 (1.36, 1.78) 0.89 (0.55, 1.43) 1.53 (1.35, 1.74) 1.37 (1.15, 1.63) I2 72% - - - 0% 73% 84% 0% Certainty of Evidence Low ⊕⊕∅∅ Low ⊕⊕∅∅ - - Moderate ⊕⊕⊕∅ Low ⊕⊕∅∅ Low ⊕⊕∅∅ Moderate ⊕⊕⊕∅ 3.1 Total hip arthroplasty The meta-analysis results of THA outcomes in SOT patients versus matched controls with their forest plots, pooled ORs and accompanying 95% CI and heterogeneity tests can be seen in Supplementary material. 3.1.1 Blood Transfusion Patients with a SOT (mixed data) had a significantly higher incidence of blood transfusion postoperatively than controls at statistical significance [OR 1.57 (1.36–1.80), very low certainty]. Liver, lung and heart transplants were also associated with a higher incidence of blood transfusion, at high, moderate and moderate certainty of evidence respectively [OR 1.51 (1.28–1.77), OR 1.71 (1.29–2.26), OR 1.57 (1.25–1.03, 1.52), respectively]. 3.1.2 Periprosthetic Joint Infection Those with a SOT (mixed data) had a higher incidence of PJI [OR 1.78 (1.01–3.12), moderate certainty]. Heart transplants were also associated with a higher incidence of PJI [OR 1.86 (1.19–2.91), moderate certainty of evidence]. There were no other significant differences between SOT and control in the other SOT subtypes. 3.1.3 Dislocation Despite the high OR favouring the control group, the difference between the SOT group (mixed data) and controls was statistically non-significant [OR 1.62, (0.94–2.78), v. low certainty]. Significant differences were found in those with kidney and heart transplants, favouring the control groups [OR 1.41, (1.16–1.73), high certainty, and OR 2.17, (1.47–3.20), moderate certainty]. 3.1.4 Periprosthetic Fracture Patients with SOT (mixed data) did not have a higher incidence of sustaining a periprosthetic fracture compared to controls [OR 1.07 (0.84–1.36), moderate certainty]. This was the case for all subtypes too. 3.1.5 Venous thromboembolism Patients with SOT (mixed data) had a significantly higher incidence of DVT but not PE compared to controls [OR 1.32 (1.04–1.66), OR 0.94 (0.66–1.34), respectively, both moderate certainty]. Kindey and heart transplants were associated with a higher incidence of DVT compared to controls [OR 1.60 (1.30–1.97), high certainty, OR 2.33 (1.54–3.51), moderate certainty, respectively] and lung transplants with a higher incidence of PE [OR 3.02 (1.24–7.34), moderate certainty]. 3.1.6 Hospital re-admission Patients with a SOT (mixed data) had a significantly higher incidence of being re-admitted to hospital within 30 days of their THA compared to controls [OR 1.62 (1.31–2.00), moderate certainty]. There were no data for SOT subtype analyses. 3.1.7 Mortality Patients with a SOT (mixed data) had a higher incidence of early mortality (up to 90 days) compared to controls [OR 2.12 (1.38–3.25), moderate certainty]. Kidney transplant patients undergoing THA had a higher incidence of 5-year mortality compared to controls in a single study [OR 2.8 (1.8–4.2), moderate certainty]. 3.1.8 All-cause revision Patients with a SOT (mixed data) did not have a higher incidence of all-cause revision compared to controls [OR 0.84 (0.58, 1.20), low certainty]. Among all subtypes, only kidney transplants were associated with a higher risk of all-cause revision [OR 1.30 (1.05–1.61), high certainty]. 3.2 Total knee arthroplasty The meta-analysis results of TKA outcomes in SOT patients versus matched controls with their forest plots, pooled ORs and accompanying 95% CI and heterogeneity tests can be seen in Supplementary material. 3.2.1 Blood Transfusion Patients with a SOT (mixed data) had a significantly higher incidence of blood transfusion postoperatively than controls at statistical significance [OR 1.37 (1.15–1.63), moderate certainty]. Among SOT subtypes, kidney and liver transplants were also associated with a higher risk [OR 1.29 (1.04–1.60), moderate certainty, and OR 1.54 (1.09–2.18), low certainty]. 3.2.2 Periprosthetic Joint Infection Those with a SOT (mixed data) had a significantly higher incidence of PJI compared to controls [OR 3.11 (1.16–8.35), low certainty]. There were also significant differences in the kidney, liver and heart subgroups [OR 3.18 (1.26–7.99), OR 2.31 (1.71–3.11), and OR 2.16 (1.42–3.28), respectively, all moderate certainty]. 3.2.3 Periprosthetic Fracture Patients with a SOT (mixed data) had a significantly higher incidence of sustaining a periprosthetic fracture compared to controls [OR 1.79 (1.36–2.36), low certainty]. Among SOT subtypes, those with a kidney transplant were at higher risk of a periprosthetic fracture compared to controls [OR 1.61 (1.14–2.29), moderate certainty]. 3.2.4 Venous thromboembolism Patients with a SOT (mixed data) had a significantly higher incidence of DVT but not PE compared to controls [OR 1.56 (1.36–1.78), moderate certainty, and OR 0.89 (0.55–1.43), low certainty, respectively]. Kindey, liver, heart and pancreas transplants were also associated with a higher incidence of DVT [OR 1.57 (1.30–1.89), moderate certainty, OR 1.58 (1.15–2.19), low certainty, OR 1.68 (1.09–2.58), low certainty, and OR 2.10 (1.14, 3.87), moderate certainty, respectively]. No SOT subtypes were associated with a higher incidence of PE. 3.2.5 All-cause revision There was a higher incidence of all-cause revision in those with a SOT (mixed data) compared to controls [OR 1.37 (1.15–1.63, moderate certainty]. A significantly higher incidence was also observed with kidney and liver transplants [OR 1.29 (1.04–1.60, and OR 1.54 (1.09, 2.18), respectively, both moderate certainty). 4 DISCUSSION The purpose of our study was to quantify the perioperative risks of complications in those with SOT with the ultimate objective to inform surgeons and patients, help with decision-making and guide the process of obtaining informed consent. We pooled the results of all SOTs together for all outcomes but also performed subgroup analyses for each subtype SOT. For the majority of outcomes, SOTs were associated with unfavourable ORs compared to controls but the certainty of evidence of each individual result ranged from very low to high. As part of the GRADE tool, this was mostly influenced by the magnitude of effect, width of the confidence intervals, clinical and statistical heterogeneity. We would advise the reader to interpret results based on low and very low certainty of evidence with caution. Our findings suggest a significantly higher incidence of blood transfusion, DVT, PJI and all-cause revision after either THA or TKA in SOT patients compared to the general population. Early postoperative mortality and 30-day re-admission rates were higher after THA in kidney transplant patients compared to controls and periprosthetic fracture incidence was higher in SOT patients undergoing TKA compared to controls. Our results are primarily based on the large database studies included in our review. For TKA in SOT patients, Klika et al. compared 6104 SOT patients with 5,870,421 controls and found an increased length of stay by almost half a day, 43% higher incidence of any complication and were more likely to need a blood transfusion [ 16 ]. Similarly, Klement et al. compared 3339 SOT patients with 1,685,295 controls and found that the higher complication incidence in the SOT group occurred in the first 90 days mostly[ 14 ]. The SOT group had a higher incidence of PJI, periprosthetic fracture and revision. Their subgroups with lung and heart transplants had the fewest complications, which is in agreement with another study that found that kidney transplants are associated with higher complications compared to non-kidney SOTs[ 26 ]. For THA, Varatharaj et al. found a significantly higher incidence of complications in the SOT group in a database study of 367,894 patients, including anaemia, acute kidney injury, blood transfusion, dislocation and PJI[ 25 ]. Klement et al. was in agreement with these findings, reporting a higher incidence of medical complications, dislocations, PJI and need for irrigation and debridement in the SOT group, with the kidney transplant subgroup carrying the worst complication profile[ 15 ]. Lung and pancreas transplants were not associated with a higher incidence of surgical complications compared to controls. The clinical outcomes of THA and TKA are also an important consideration. The limited existing literature appears to be in agreement about the good efficacy of both THA and TKA with regard to meaningful improvements in functional, pain and quality of life scores [ 6 , 27 – 29 ]. However, these good outcomes come at an expense of higher incidence of complications as well as higher healthcare costs, extended hospital stays and readmissions[ 1 , 27 , 30 , 31 ]. The incidence of early mortality is also higher in SOT patients compared to the general population, as shown in our study. Two studies with mixed THA and TKA data found no differences in mortality in liver transplant patients compared to controls (OR 0.7 and 1.2) and another one in kidney transplant patients also found a similar incidence of mortality at one year in those undergoing THA or TKA compared to those that did not undergo surgery [ 11 , 12 , 17 ]. However, a study also reporting mixed THA and TKA data that included all types of SOTs found a significantly higher incidence of death in those with any SOT type undergoing total joint arthroplasty compared to the general population (OR 7.42), however the deaths occurred at an average of 3.83 years post-operatively, therefore it is not possible to make conclusions on causality as early mortality rates are not reported[ 1 ]. The existing evidence on implant survival in SOT patients is scarce. In the study by Chalmers et al., two-year and 5-year survival were 94% and 92%, respectively, which are similar to those reported by Wu et al. that included both THA and TKA patients (96% on-year, 94% 4-year survival)[ 32 , 33 ]. Similar survivorship was reported in TKA, with survival rates of 98% at 2 years and 93% at 5 years having been described by Ledford et al.[ 34 ]. Whilst these figures are acceptable for a high-risk population, they are significantly lower than the survival rates of the general population, which are around 98.5% and 97.2% for THA and 97.6% and 96.1% for TKA at 5 and 10 years, respectively, according to the most recently published National Joint Registry report[ 35 ]. This is consistent with the findings of the present study demonstrating a higher incidence of all-cause revision in SOT patients undergoing THA and TKA compared to controls; this should be clearly communicated to the patient by the surgeon, highlighting the challenges associated with a potential revision procedure with regard to both surgical complexity as well as complication risks. Despite the higher complication profile of THA and TKA in SOT patients compared to the general population, the improved clinical outcomes reported in the existing literature should be strongly considered. Decisions should be made on an individual basis considering several factors such as frailty, influence of arthritis on quality of life, severity of pain, baseline mobility and other comorbidities, and should be made mutually by surgeon and patient after a rigorous informed consent process. Anaesthetic and general medical involvement should be sought in decision-making and pre-operative patient optimisation to minimise the risk of complications as much as possible. Our study has limitations, which are mostly secondary to the inherent drawbacks of the included evidence. All included studies are retrospective reviews which included heterogeneous outcomes and procedures with different implants and postoperative care; however the quality of the majority of them was found to be good at our study quality assessment. More than half of the included studies did not match their exposure group to control patients with propensity score matching which introduces risk of bias and finally, retrospective database studies rely on data having been recorded appropriately and they often suffer from coding/indexing inconsistencies which may influence their results. 5 CONCLUSION We have found increased incidence of blood transfusion, PJI, DVT and all-cause revision after either a THA or TKA in SOT patients compared to the general population. We have quantified these risks in the present study and have assigned a certainty of evidence for each reported result. Decisions should be made on an individual basis in a multidisciplinary approach and after the risks and benefits of the procedure are explained to the patient in detail. Declarations Conflicts of interest : None of the authors have any conflicts of interest to declare Funding: MRC Grant MR/X036766/1. Human Ethics and Consent to Participate : not applicable Author Contribution DC Conceptualisation, meta-analyses, certainty of evidence assessments, coordination and authoring manuscript, RR/ER/AP/AA data collection and study quality assessment, NM/BJ general supervision, final editing of manuscript. All authors approved the final version of the manuscript prior to submission. Acknowledgments: none Data Availability Data is provided within the manuscript or supplementary information files References Brown N, Ralles S, Kroin E, Adams W, Wu K. Complications of total joint arthroplasty in solid organ transplant patients versus a large control group. J Clin Orthop Trauma. 2020;11(1):91–5. Israni AK, Zaun D, Hadley N, Rosendale JD, Schaffhausen C, McKinney W, et al. Am J Transpl Off J Am Soc Transpl Am Soc Transpl Surg. 2020;20(Suppl s):509–41. OPTN/SRTR 2018 Annual Data Report: Deceased Organ Donation. Marston SB, Gillingham K, Bailey RF, Cheng EY. 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Primary Total Knee Arthroplasty After Solid Organ Transplant: Survivorship and Complications. J Arthroplasty. 2017;32(1):101–5. National Joint Registry - Annual Report. 2024 [Internet]. The National Joint Registry. 2024 [cited 2025 Jul 16]. Available from: https://www.njrcentre.org.uk/national-joint-registry-annual-report-2024/ Additional Declarations No competing interests reported. Supplementary Files SupplementaryFigureswithlegendsSOTArthroplasty.docx Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 01 Sep, 2025 Reviews received at journal 30 Aug, 2025 Reviews received at journal 28 Aug, 2025 Reviewers agreed at journal 27 Aug, 2025 Reviewers agreed at journal 25 Aug, 2025 Reviewers invited by journal 25 Aug, 2025 Editor assigned by journal 24 Jul, 2025 Submission checks completed at journal 24 Jul, 2025 First submitted to journal 22 Jul, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7185982","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":508444252,"identity":"cfd1ea1b-c21e-4ffb-9be4-ee296a528169","order_by":0,"name":"Dimitris Challoumas","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA/ElEQVRIiWNgGAWjYDCCAzwMDA8KwEzGx2CKmbkBTEvg05JgAFFrzMAAZDEzEq+FTRqshYGAFr7jZw9+SDCwSVzbfvxZdUHFn2j+dqCWHxUMiTMbsGuRPJOXLJFgkJa47UyO2e0ZZwxyZxxmbGDsOcOQOBuHLQY3eAyAWg4nbjuQw3abt80gtwGohZmxjSFxHm4txj/AWs4/f1YM0jKfCC1mEFtuJJgxg7RsgGnB5TBJoBcsgH4x3nbjjbE0zxnj3I1ALQd7zkgY4/I+3/Ezxjc+VNjIbjuf/vAzT4Vc7rzzhw8++AEUmXEAhzVYwQE8ETkKRsEoGAWjgAgAADiMYODIwPOGAAAAAElFTkSuQmCC","orcid":"","institution":"University of Glasgow","correspondingAuthor":true,"prefix":"","firstName":"Dimitris","middleName":"","lastName":"Challoumas","suffix":""},{"id":508444253,"identity":"4c0f82b4-2488-428d-ae37-40ee4ea014c0","order_by":1,"name":"Rohan Ramasubbu","email":"","orcid":"","institution":"Glasgow Royal Infirmary","correspondingAuthor":false,"prefix":"","firstName":"Rohan","middleName":"","lastName":"Ramasubbu","suffix":""},{"id":508444254,"identity":"d7e3e26d-281d-43f3-aa6e-e8b456a86a7c","order_by":2,"name":"Elliot Rooney","email":"","orcid":"","institution":"Glasgow Royal Infirmary","correspondingAuthor":false,"prefix":"","firstName":"Elliot","middleName":"","lastName":"Rooney","suffix":""},{"id":508444255,"identity":"6dd02256-70ed-464b-b232-413f787e4b5f","order_by":3,"name":"Angus Paterson","email":"","orcid":"","institution":"Glasgow Royal Infirmary","correspondingAuthor":false,"prefix":"","firstName":"Angus","middleName":"","lastName":"Paterson","suffix":""},{"id":508444256,"identity":"759fc795-9a59-4e58-9fe9-db3892358709","order_by":4,"name":"Almigdad Ali","email":"","orcid":"","institution":"Glasgow Royal Infirmary","correspondingAuthor":false,"prefix":"","firstName":"Almigdad","middleName":"","lastName":"Ali","suffix":""},{"id":508444257,"identity":"2df2eefa-104c-44c9-94b7-63fefc5126d4","order_by":5,"name":"Neal Millar","email":"","orcid":"","institution":"University of Glasgow","correspondingAuthor":false,"prefix":"","firstName":"Neal","middleName":"","lastName":"Millar","suffix":""},{"id":508444258,"identity":"fa66aa40-b239-4ec9-9fc1-c038ed85f033","order_by":6,"name":"Bryn Jones","email":"","orcid":"","institution":"Glasgow Royal Infirmary","correspondingAuthor":false,"prefix":"","firstName":"Bryn","middleName":"","lastName":"Jones","suffix":""}],"badges":[],"createdAt":"2025-07-22 10:38:27","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7185982/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7185982/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":90378912,"identity":"245cb666-8844-4949-9004-e19611d9b16c","added_by":"auto","created_at":"2025-09-02 06:25:25","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2020847,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7185982/v1/938bd487-5338-4065-8fed-8fe42be2865e.pdf"},{"id":90377440,"identity":"f17eae67-19d9-4e5e-b018-c8f1e4325574","added_by":"auto","created_at":"2025-09-02 06:09:24","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":1799995,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryFigureswithlegendsSOTArthroplasty.docx","url":"https://assets-eu.researchsquare.com/files/rs-7185982/v1/22e17a3f9cb795e256be7620.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Complications of total hip and knee arthroplasty in solid organ transplant patients: a systematic review and meta-analysis","fulltext":[{"header":"1 INRODUCTION","content":"\u003cp\u003eLongevity of patients with solid organ transplants (SOT; kidney, liver, pancreas, heart and lung) is continuously increasing thanks to improvements in perioperative management and immunosuppressive treatment[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. In addition to the patients with SOT who go on to develop arthritis at incidences similar to the general population, the immunosuppressive regimes can be responsible for avascular necrosis, usually of the femoral head, which has been estimated at an overall rate of 5% in this group of patients[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. As a result, transplant patients have approximately a fivefold increased incidence of needing a joint replacement compared to the general population[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e\u003cp\u003ePrevious literature has reported significant improvements in clinical outcomes in SOT patients undergoing total hip arthroplasty (THA) or total knee arthroplasty (TKA)[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. However, there remains a question whether these benefits outweigh the risks, which are primarily driven by the medical complexity of this group of patients and the requirement of lifelong immunosuppression. Decisions on whether to proceed to total joint arthroplasty surgery in SOT patients should be made on a multidisciplinary basis, involving all implicated medical professionals (surgeon, anaesthetist, internal medicine physician) and, especially, the patients themselves, after careful consideration of the patient as an individual and the impact of the arthritis on their quality of life.\u003c/p\u003e\u003cp\u003eCurrent data on complication profiles of THA and TKA in SOT patients are mostly based on retrospective reviews of database registries and they can be challenging to interpret separately due to the several types of complication outcomes reported and subgroup data for each transplant type and also arthroplasty procedure (THA vs TKA). Our aim was to systematically identify, present and summarise all the relevant existing evidence and quantify the risks of complications, with the ultimate objective to inform implicate healthcare professionals and patients and guide the informed consent process.\u003c/p\u003e"},{"header":"2 MATERIALS AND METHODS","content":"\u003cp\u003eThis systematic review and meta-analysis was prospectively registered on PROSPERO (CRD42023399043) and was conducted as per PRISMA guidance[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003e2.1 Eligibility criteria\u003c/h2\u003e\u003cdiv id=\"Sec4\" class=\"Section3\"\u003e\u003ch2\u003e2.1.1 Types of studies\u003c/h2\u003e\u003cp\u003eObservational studies that included a control group were eligible for inclusion. Only studies published in English were screened for inclusion.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec5\" class=\"Section3\"\u003e\u003ch2\u003e2.1.2 Exposure\u0026mdash;control\u003c/h2\u003e\u003cp\u003eStudies of patients with any type of SOT undergoing a primary THA or TKA were eligible if they also included a matched control population without SOT. The present study excluded trials with (1) revision THA or TKA, (2) arthroplasty of joints other than hip or knee, (3) partial hip (hemiarthroplasty) or knee (unicompartmental) arthroplasty, (4) studies that only assessed outcomes in SOT patients without a matched control (i.e., case series), (5) studies with patients with non-solid organ transplants (e.g. bone marrow).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec6\" class=\"Section3\"\u003e\u003ch2\u003e2.1.3 Types of outcome measures\u003c/h2\u003e\u003cp\u003eIncidence of blood transfusion, periprosthetic joint infection (PJI), dislocation (THA only), venous thromboembolism (deep venous thrombosis and pulmonary embolism), mortality and all-cause revision.\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\u003ch2\u003e2.2 Literature search\u003c/h2\u003e\u003cp\u003eSearch strategies were developed in \u0026lsquo;all fields\u0026rsquo; with the following search terms: a) \u0026lsquo;(solid organ transplant OR kidney transplant OR renal transplant OR liver transplant OR heart transplant OR lung transplant OR pancreas transplant) AND (arthroplasty OR joint replacement OR joint arthroplasty OR knee arthroplasty OR hip arthroplasty OR knee replacement OR hip replacement)\u0026rsquo;.\u003c/p\u003e\u003cp\u003eThe following databases were screened for published and unpublished trials from inception to March 2025 by two authors: Medline and Embase (via Ovid), Cochrane central and OpenGrey.eu. For unpublished or ongoing studies, we searched the WHO International Clinical Trials Registry Platform (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://apps.who.int/trialsearch/\u003c/span\u003e\u003cspan address=\"http://apps.who.int/trialsearch/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003cb\u003e)\u003c/b\u003e Clinical Trials.gov, The European Union Clinical Trials Register and the ISRCTN registry. The reference and citation lists of all eligible studies were screened for further eligible trials. The PRISMA flowchart is illustrated in the Supplementary Material. A total of 533 studies were identified after removal of duplicates and their titles were screened. After removal of non-eligible study types, the abstracts and full texts of the remaining studies were screened for inclusion by two authors independently. The PRISMA flow diagram (Supplementary material) summarises the article selection process.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003e2.3 Data extraction\u003c/h2\u003e\u003cp\u003ePatient and intervention characteristics, outcome measures and follow up duration were extracted from individual trials and recorded in Microsoft Word version 16.43 (Microsoft corp) by two authors separately in a previously constructed standardised data collection form. For missing data, attempts were made to contact the corresponding authors of studies published in the last 5 years.\u003c/p\u003e\u003cdiv id=\"Sec9\" class=\"Section3\"\u003e\u003ch2\u003e2.3.1 Data handling\u0026mdash;synthesis of results\u003c/h2\u003e\u003cp\u003eStudies assessing the same outcome measures in patients with SOT and matched controls were pooled in pairwise meta-analyses in the absence of significant clinical heterogeneity (similar populations, follow up time points and interventions). Data were pooled separately for each SOT type (kidney, liver, heart, lung, pancreas) where sufficient data available, and also for all SOT types combined. This was done for TKA and THA separately and not for combined THA/TKA outcomes as there were no outcomes for which two or more mixed THA/TKA studies reported data, therefore pooling could not be performed for mixed THA/TKA data. ratios (ORs) with 95% confidence interval (CI) were used for all outcomes.\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\u003ch2\u003e2.4 Risk of bias and strength of evidence assessment\u003c/h2\u003e\u003cp\u003eThe Newcastle-Ottawa Scale (NOS) for cohort studies was used to assess risk of bias (RoB)[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. The thresholds recommended within the tool for converting NOS scores to Agency for Healthcare Research and Quality (AHRQ) standards (good, fair and poor quality) were used.\u003c/p\u003e\u003cp\u003eThe Grading of Recommendations Assessment, Development and Evaluation (GRADE) tool was used to appraise the certainty (strength) of evidence[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. For pairwise meta-analyses, certainty of evidence was assessed based on five domains: overall RoB, imprecision, inconsistency, indirectness and other confounding factors (including publication bias). The result of each comparison of interventions was assigned one of high, moderate, low or very low certainty of evidence. The certainty of evidence started from \u0026lsquo;high\u0026rsquo;, as the included studies were diagnostic rather than designed to assess interventions and was downgraded for one step each time when any one of the five domains raised concerns. The certainty of evidence was upgraded when the magnitude of effect was very large and at statistical significance and when the confidence intervals were very narrow (downgraded when very wide). When the overall results were based on data from one study only, the certainty of evidence started at \u0026ldquo;moderate\u0026rdquo;. For the combined SOT results, the certainty of evidence was always downgraded by one level for indirectness (clinical heterogeneity, different transplant types).\u003c/p\u003e\u003cp\u003eFor both RoB and certainty of evidence assessment, studies were assessed by two authors separately and controversies were resolved with involvement of the senior author.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003e2.5 Statistical analysis\u003c/h2\u003e\u003cp\u003eThe Review Manager V.5 (RevMan) software was used to calculate pooled ORs and generate forest plots for pairwise meta-analyses and their accompanying heterogeneity tests (Chi\u003csup\u003e2\u003c/sup\u003e and \u003cem\u003eI\u003c/em\u003e\u003csup\u003e2\u003c/sup\u003e).\u003c/p\u003e\u003cp\u003ePotential publication bias was not assessed as no pairwise meta-analyses included more than 10 studies. Expecting wide-range variability in studies\u0026rsquo; settings, a random-effects model was employed in all meta-analyses.\u003c/p\u003e\u003c/div\u003e"},{"header":"3 RESULTS","content":"\u003cp\u003eA total of 17 studies were found to be eligible and were included[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan additionalcitationids=\"CR11 CR12 CR13 CR14 CR15 CR16 CR17 CR18 CR19 CR20 CR21 CR22 CR23 CR24\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Four studies did not participate in meta-analyses as they reported mixed results of THA and TKA in SOT patients vs controls[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. From the 13 studies that contributed to meta-analyses, 10 were on THA and 3 on TKA. Their characteristics are shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eStudy characteristics table\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFirst author et al. (year)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eProcedure (THA vs TKA)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSOT Type (kidney, liver, etc)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePopulation n\u0026thinsp;=\u0026thinsp;X, mean age\u0026thinsp;=\u0026thinsp;X in each group\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eExposure vs Control matched for?\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eOutcomes assessed\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eFollow-up period for revision and PJI\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLim et al. (2021)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTHA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eKidney\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eControl group n\u0026thinsp;=\u0026thinsp;72 with 94 THA (mean age 45 years)\u003c/p\u003e\u003cp\u003eSOT group n\u0026thinsp;=\u0026thinsp;30 patients with 45 THA (mean age 44 yes)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eSex, BMI, age, AVN, Duration of follow-up\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003ePre and post op Harris Hip score\u003c/p\u003e\u003cp\u003eRadiographic: wear, loosening, ectopic ossification\u003c/p\u003e\u003cp\u003eComplications: Infection, dislocation, PPF, DVT, wound issues, nerve palsy, revision\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eMinimum 2 year follow-up.\u003c/p\u003e\u003cp\u003eMean follow-up 7.2 years for both groups.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMcleery et al. (2010)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTKA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eKidney\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eControl group n\u0026thinsp;=\u0026thinsp;55570\u003c/p\u003e\u003cp\u003eSOT group n\u0026thinsp;=\u0026thinsp;25\u003c/p\u003e\u003cp\u003e(mean ages not stated)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eNot matched\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eEarly (\u0026lt;\u0026thinsp;90 days) and late infection (\u0026gt;\u0026thinsp;90 days)\u003c/p\u003e\u003cp\u003eEarly (\u0026lt;\u0026thinsp;365 days) and late\u0026thinsp;\u0026gt;\u0026thinsp;365 days) all-cause revision\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eNot specified. Late revision was \u0026gt;\u0026thinsp;365 days.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAgarwal et al. (2021)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTHA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eKidney, heart, lung, liver, pancreas\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eControl group n\u0026thinsp;=\u0026thinsp;6196 (mean age 60\u0026ndash;70 years)\u003c/p\u003e\u003cp\u003eSOT group n\u0026thinsp;=\u0026thinsp;3103 (mean age 60\u0026ndash;70 years)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eAge, gender, Charlson Comorbidity Index, obesity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003ePJI, DVT, PT, mortality, blood transfusion, all-cause revision\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eMinimum 2 years follow-up\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNavale et al. (2017)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTHA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eKidney, heart, lung, liver, pancreas\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eControl group population 2,772,943 (mean age 60\u0026ndash;70 years)\u003c/p\u003e\u003cp\u003eSOT group n\u0026thinsp;=\u0026thinsp;7558 (mean age 50\u0026ndash;60 years)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eAge, sex, race, insurance, hospital region, hospital location and bed size, teaching hospital\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003ePJI, dislocation, DVT, PT, blood transfusion\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eNA\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eKlement et al. (2016)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTKA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eKidney, liver, lung, heart and pancreas\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eControl group n\u0026thinsp;=\u0026thinsp;1685295 (mean age 65\u0026ndash;69 yars)\u003c/p\u003e\u003cp\u003eSOT group n\u0026thinsp;=\u0026thinsp;3334 (mean age\u0026thinsp;\u0026lt;\u0026thinsp;65 years)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eNot matched\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eMedical and Surgical Outcomes at 30, 90 and \u0026ldquo;overall\u0026rdquo;\u003c/p\u003e\u003cp\u003eMedical \u0026ndash; MI, HF, Arrythmia with and without AF, respiratory failure, DVT, PE, CVA, PNA, sepsis/SIRS, acute renal failure, anaemia, blood transfusion\u003c/p\u003e\u003cp\u003eSurgical \u0026ndash; MUA, Periproshetic infection, PPF, TKA revision, arthrotomy, patellar complications, extensor mechanism rupture\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eMinimum 2 years follow-up\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDouglas et al. (2021)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTHA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eLiver\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eControl group n\u0026thinsp;=\u0026thinsp;10246 (mean age 60 years)\u003c/p\u003e\u003cp\u003eSOT group n\u0026thinsp;=\u0026thinsp;513 (mean age 60 years)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eAge, gender, Charlson Comorbidity Index, obesity and diabetes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eLOS, readmissions, blood transfusion, MI, DVT, PE, pneumonia, resp failure, dislocation, mechanical complications (PPF, aspectic loosening, Periprosthetic oseolysis)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e90 days, 1 year, 2 years and 5 years\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eQuinlan et al. (2022)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTHA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eHeart, lung, kidney, pancreas, liver\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eControl group n\u0026thinsp;=\u0026thinsp;4980 (mean age\u0026thinsp;\u0026lt;\u0026thinsp;64 years)\u003c/p\u003e\u003cp\u003eSOT group n\u0026thinsp;=\u0026thinsp;996 (mean age\u0026thinsp;\u0026lt;\u0026thinsp;64 years)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eAge, gender, tobacco use, Diabetes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eDeath, Hospital admission 30 and 90d), ER visit (30 and 90d), infection, all-cause revision, aseptic revision, dislocation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1 year\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMalkani et al. (2020)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTHA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eKidney\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eSOT group n\u0026thinsp;=\u0026thinsp;94 (mean age not reported)\u003c/p\u003e\u003cp\u003eControl group n\u0026thinsp;=\u0026thinsp;54,902 (mean age not reported)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eNot matched\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eVTE, PJI, Dislocation, readmission, mortality. All were over 90d, 0.5y, 1y, 2y \u0026amp; 5y.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e5 years\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTornero et al. (2015)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTHA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eKidney\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eSOT group n\u0026thinsp;=\u0026thinsp;15 (mean age 53.8 years)\u003c/p\u003e\u003cp\u003eControl group n\u0026thinsp;=\u0026thinsp;74 (mean age 68.0 years)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eNot matched\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eBlood\u003c/p\u003e\u003cp\u003etransfusion, LOS, early postopeative complications (early PJI, dislocation, systemic infections, DVT \u0026amp; other complications), rate of revision (aseptic loosening, PJI or fracture) and overall prosthesis survival (1, 2, 5 \u0026amp; 10 years)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e10y\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eKlika et al. (2015)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTKA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSOT (not specified)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eControl group n\u0026thinsp;=\u0026thinsp;5,864,317 (mean age 66.8 years)\u003c/p\u003e\u003cp\u003eSOT group n\u0026thinsp;=\u0026thinsp;6,104 (mean age 60.8 years)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003ePatient characteristics (sex, age, race,\u003c/p\u003e\u003cp\u003ehousehold income, primary payer source) Hospital characteristics (region, bed size, location, surgeon volume, hospital volume) and comorbidities.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eLOS, costs per admission,\u003c/p\u003e\u003cp\u003eand perioperative complications and adverse events [Medical complications, need for blood transfusion and surgical complications (either related to implant, eg; dislocation and fractures, or general, eg; wound related, DVT/PE,\u0026hellip;)].\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003enot specified -infection rates are limited to the perioperative hospital stay until discharge.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eKlement et al. (2017)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTHA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eKidney, liver, lung, heart \u0026amp; pancreas\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eControl group n\u0026thinsp;=\u0026thinsp;771,498 (\u0026gt;\u0026thinsp;65% 65-79y age range)\u003c/p\u003e\u003cp\u003eSOT group n\u0026thinsp;=\u0026thinsp;3,180 [Kidney n\u0026thinsp;=\u0026thinsp;2,321, Liver n\u0026thinsp;=\u0026thinsp;561, Lung n\u0026thinsp;=\u0026thinsp;196, Heart n\u0026thinsp;=\u0026thinsp;428, Pancreas n\u0026thinsp;=\u0026thinsp;149] (\u0026gt;\u0026thinsp;60% were less than 60yrs of age).\u003c/p\u003e\u003cp\u003eNo mean age was provided.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eNot matched\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eA list of medical complications by 30 days post op, and surgical complications (PJI, dislocation, fracture, osteolysis\u0026thinsp;+\u0026thinsp;poly wear, mechanical complications, revision and arthrotomy/I\u0026amp;D.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eMinimum 2 years\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOya et al. (2021)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTHA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eLiver\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eControl group n\u0026thinsp;=\u0026thinsp;27 (mean age 55.8 years)\u003c/p\u003e\u003cp\u003eSOT group n\u0026thinsp;=\u0026thinsp;7 with 9 THA (mean age 58.4 years)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eNot matched\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eFBC, UE\u0026rsquo;s, LFT\u0026rsquo;s, opera-\u003c/p\u003e\u003cp\u003etive time, intraoperative blood loss, incidence of perioperative\u003c/p\u003e\u003cp\u003ecomplications, and Harris Hip Score (HHS)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eMean 46.3 months (Range 24\u0026ndash;60 months)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVaratharaj 2022\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTHA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNot listed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eControl group n\u0026thinsp;=\u0026thinsp;367894 (mean age 66 years)\u003c/p\u003e\u003cp\u003eSOT group n\u0026thinsp;=\u0026thinsp;813 (mean age 61 years)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eNot matched\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eMedical and Surgical Outcomes\u003c/p\u003e\u003cp\u003e(elective procedure, dislocation, mortality/death, hematoma,\u003c/p\u003e\u003cp\u003ewound disruption, infection, anemia, acute renal failure,\u003c/p\u003e\u003cp\u003ehypotension, pulmonary embolism, myocardial infarction,\u003c/p\u003e\u003cp\u003epneumonia, blood transfusions, intra-operative complications, deep\u003c/p\u003e\u003cp\u003evenous thrombosis, stroke, peri-prosthetic fractures, prosthetic\u003c/p\u003e\u003cp\u003ehip dislocations, prosthetic loosening, length of stay, and health care-\u003c/p\u003e\u003cp\u003erelated expenditure).\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eNot reported\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eFollow-up duration ranged from 1 to 10 years; 4 studies had a minimum follow-up of 2 years in all included patients. Matching of SOT patients with controls was performed in 7 studies. Details on perioperative immunosuppressive therapy were not provided by most studies and we assume there was significant heterogeneity in this both across and within studies. There was also poor reporting and, consequently, assumed high heterogeneity with regard to type of arthroplasty implants and use of cement.\u003c/p\u003e\u003cp\u003eStudy quality was found to be \u0026lsquo;good\u0026rsquo; in 15 studies and \u0026lsquo;poor\u0026rsquo; in two studies (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). The certainty of evidence was therefore not downgraded for high risk of bias for any of the results.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eStudy quality assessment with Newcastle-Ottawa tool.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"10\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e\u003cp\u003eSelection\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eComparability\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c9\" namest=\"c7\"\u003e\u003cp\u003eOutcome\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c10\"\u003e\u003cp\u003eOverall\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eStudy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e1\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e2\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e3\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e4\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e1\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e1\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003e2\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cb\u003e3\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLim 2021\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e✓\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e✓\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e✓\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e✓\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e✓ ✓\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e✘\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003e✓\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cb\u003e✓\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eGood quality\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMcleery 2010\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e✘\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e✘\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e✓\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e✓\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e✘✘\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e✘\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e✘\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e✘\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003ePoor quality\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAgarwal 2021\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e✓\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e✓\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e✓\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e✓\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e✓ ✓\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e✓\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003e✓\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cb\u003e✓\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eGood quality\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNavale 2017\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e✓\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e✓\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e✓\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e✓\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e✓ ✓\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e✓\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e✘\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cb\u003e✓\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eGood quality\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eKlement 2016\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e✓\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e✓\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e✓\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e✓\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e✘ \u003cb\u003e✓\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e✓\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003e✓\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e✘\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eGood quality\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAhmed 2023\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e✓\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e✓\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e✓\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e✓\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e✓ ✓\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e✓\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003e✓\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cb\u003e✓\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eGood quality\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDouglas 2021\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e✓\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e✓\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e✓\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e✓\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e✓ ✓\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e✓\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003e✓\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e✘\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eGood Quality\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eQuinlan\u003c/p\u003e\u003cp\u003e2022\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e✓\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e✓\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e✓\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e✓\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e✓ ✓\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e✓\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e✘\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cb\u003e✓\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eGood Quality\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMalkani et al. (2020)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e✓\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e✓\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e✓\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e✓\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e✘\u003cb\u003e✓\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e✓\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003e✓\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e✘\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eGood quality\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTornero et al (2015)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e✓\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e✓\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e✓\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e✓\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e✘\u003cb\u003e✓\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e✓\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003e✓\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e✘\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eGood quality\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eKilka et al. (2015)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e✓\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e✓\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e✓\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e✓\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e✓✓\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e✓\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e✘\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cb\u003e✓\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eGood quality\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eKlement et al. (2017)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e✓\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e✓\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e✓\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e✓\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e✘\u003cb\u003e✓\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e✓\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003e✓\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cb\u003e✓\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eGood quality\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eKuo 2018\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e✓\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e✓\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e✓\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e✓\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e✓ ✓\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e✓\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003e✓\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cb\u003e✓\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eGood quality\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBrown 2020\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e✓\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e✓\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e✓\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e✓\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e✓ ✓\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e✓\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003e✓\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cb\u003e✓\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eGood quality\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOya 2021\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e✘\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e✓\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e✓\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e✓\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e✓\u003c/b\u003e ✘\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e✓\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003e✓\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e✘\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eGood quality\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVaratharaj 2022\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e✓\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e✓\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e✓\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e✓\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e✘✘\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e✓\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003e✓\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cb\u003e✓\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003ePoor quality\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDodin 2021\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e✓\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e✓\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e✓\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e✓\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e✓\u003c/b\u003e ✘\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e✓\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003e✓\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cb\u003e✓\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eGood quality\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e provides a summary of the results of each study per outcome measure and the results of pooling, where performed, with the accompanying certainty of evidence for each pooled result. In the text below, we present the results of the meta-analyses of all SOT types analysed together and those specific SOT types with statistically significant results. All other results are summarised in Table \u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e, with their accompanying certainty of evidence.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003e\u003cb\u003eMain results.\u003c/b\u003e Statistical significance is denoted by confidence intervals that do not include \u0026ldquo;1\u0026rdquo;.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"13\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c13\" colnum=\"13\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTransplant type\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eFirst author (year)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePJI\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003ePP#\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003e30day re-admission\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eDislocation (THA only)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003eDVT\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\"\u003e\u003cp\u003ePE\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c10\"\u003e\u003cp\u003eMortality\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c11\"\u003e\u003cp\u003eBlood transfusion\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c12\"\u003e\u003cp\u003eAll cause revision\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c13\"\u003e\u003cp\u003eNotes\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"23\" rowspan=\"24\"\u003e\u003cp\u003e\u003cb\u003eTHA only\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e\u003cb\u003eKidney\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNumber of studies (total n SOT/Control)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4 (2478/826572)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2 (2384/771670)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e4 (2478/826572)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e2 (2384/771670)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e1 (2321/771498)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e1\u003c/p\u003e\u003cp\u003e(8669 /54934)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e2 (2339/771574)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e2 (2346/1740865)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003eMean OR (95% CI)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e1.50 (0.65, 3.49)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e1.09 (0.81, 1.48)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e-\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e1.41 (1.16, 1.73)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003e1.60 (1.30, 1.97)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cb\u003e0.90 (0.57, 1.43)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e\u003cb\u003e2.8 (1.8, 4.2)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e\u003cb\u003e2.39 (0.63, 9.00)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e\u003cb\u003e1.30 (1.05, 1.61)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eI2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e32%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e83%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003eCertainty of Evidence\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003eModerate\u003c/b\u003e\u0026oplus;\u0026oplus;\u0026oplus;\u0026empty;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003eHigh\u003c/b\u003e\u0026oplus;\u0026oplus;\u0026oplus;\u0026oplus;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e-\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003eHigh\u003c/b\u003e\u0026oplus;\u0026oplus;\u0026oplus;\u0026oplus;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003eHigh\u003c/b\u003e\u0026oplus;\u0026oplus;\u0026oplus;\u0026oplus;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cb\u003eModerate\u003c/b\u003e\u0026oplus;\u0026oplus;\u0026oplus;\u0026empty;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e\u003cb\u003eModerate\u003c/b\u003e\u0026oplus;\u0026oplus;\u0026oplus;\u0026empty;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e\u003cb\u003eLow\u003c/b\u003e\u0026oplus;\u0026oplus;\u0026empty;\u0026empty;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e\u003cb\u003eHigh\u003c/b\u003e\u0026oplus;\u0026oplus;\u0026oplus;\u0026oplus;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e\u003cb\u003eLiver\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNumber of studies (total n SOT/Control)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2 (1074/19961)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2 (570/771525)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e2 (1083/781771)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e2 (1083/781771)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e3 (1083/781771)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e2 (1074/781744)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e2 (1074/781744)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003eMean OR (95% CI)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e1.41 (0.94, 2.12)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e0.54 (0.23, 1.27)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e-\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e1.09 (0.76, 1.56)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003e1.25 (0.76, 2.05)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cb\u003e0.77 (0.39, 1.52)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e\u003cb\u003e-\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e\u003cb\u003e1.51 (1.28, 1.77)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e\u003cb\u003e0.72 (0.48, 1.07)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eI2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e14%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e43%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003eCertainty of Evidence\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003eModerate\u003c/b\u003e\u0026oplus;\u0026oplus;\u0026oplus;\u0026empty;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003eModerate\u003c/b\u003e\u0026oplus;\u0026oplus;\u0026oplus;\u0026empty;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e-\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003eModerate\u003c/b\u003e\u0026oplus;\u0026oplus;\u0026oplus;\u0026empty;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003eModerate\u003c/b\u003e\u0026oplus;\u0026oplus;\u0026oplus;\u0026empty;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cb\u003eModerate\u003c/b\u003e\u0026oplus;\u0026oplus;\u0026oplus;\u0026empty;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e\u003cb\u003e-\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e\u003cb\u003eHigh\u003c/b\u003e\u0026oplus;\u0026oplus;\u0026oplus;\u0026oplus;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e\u003cb\u003eHigh\u003c/b\u003e\u0026oplus;\u0026oplus;\u0026oplus;\u0026oplus;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e\u003cb\u003eLung\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNumber of studies (total n SOT/Control)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1 (196/771498)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1 (196/771498)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1 (196/771498)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1 (196/771498)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e1 (196/771498)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e1 (196/771498)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e1 (196/771498)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003eMean OR (95% CI)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e0.99 (0.41, 2.41)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e1.52 (0.63, 3.70)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e-\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e0.84 (0.35, 2.05)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003e1.03 (0.42, 2.49)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cb\u003e3.02 (1.24, 7.34)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e\u003cb\u003e-\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e\u003cb\u003e1.71 (1.29, 2.26)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e\u003cb\u003e0.55 (0.22, 1.33)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eI2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003eCertainty of Evidence\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003eLow\u003c/b\u003e\u0026oplus;\u0026oplus;\u0026empty;\u0026empty;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003eLow\u003c/b\u003e\u0026oplus;\u0026oplus;\u0026empty;\u0026empty;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e-\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003eLow\u003c/b\u003e\u0026oplus;\u0026oplus;\u0026empty;\u0026empty;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003eLow\u003c/b\u003e\u0026oplus;\u0026oplus;\u0026empty;\u0026empty;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cb\u003eModerate\u003c/b\u003e\u0026oplus;\u0026oplus;\u0026oplus;\u0026empty;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e\u003cb\u003e-\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e\u003cb\u003eModerate\u003c/b\u003e\u0026oplus;\u0026oplus;\u0026oplus;\u0026empty;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e\u003cb\u003eLow\u003c/b\u003e\u0026oplus;\u0026oplus;\u0026empty;\u0026empty;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e\u003cb\u003eHeart\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNumber of studies (total n SOT/Control)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1 (428/771498)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1 (428/771498)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1 (428/771498)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1 (428/771498)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e1 (428/771498)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e1 (428/771498)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e1 (428/771498)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003eMean OR (95% CI)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e1.86 (1.19, 2.91)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e0.69 (0.28, 1.66)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e-\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e2.17 (1.47, 3.20)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003e2.33 (1.54, 3.51)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cb\u003e1.36 (0.56, 3.29)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e\u003cb\u003e-\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e\u003cb\u003e1.25 (1.03, 1.52)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e\u003cb\u003e1.13 (0.74, 1.74)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eI2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003eCertainty of Evidence\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003eModerate\u003c/b\u003e\u0026oplus;\u0026oplus;\u0026oplus;\u0026empty;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003eLow\u003c/b\u003e\u0026oplus;\u0026oplus;\u0026empty;\u0026empty;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e-\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003eModerate\u003c/b\u003e\u0026oplus;\u0026oplus;\u0026oplus;\u0026empty;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003eModerate\u003c/b\u003e\u0026oplus;\u0026oplus;\u0026oplus;\u0026empty;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cb\u003eLow\u003c/b\u003e\u0026oplus;\u0026oplus;\u0026empty;\u0026empty;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e\u003cb\u003e-\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e\u003cb\u003eModerate\u003c/b\u003e\u0026oplus;\u0026oplus;\u0026oplus;\u0026empty;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e\u003cb\u003eLow\u003c/b\u003e\u0026oplus;\u0026oplus;\u0026empty;\u0026empty;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e\u003cb\u003ePancreas\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNumber of studies (total n SOT/Control)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1 (149/771498)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1 (149/771492)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1 (149/771492)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1 (149/771492)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e1 (149/771498)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e1 (149/771492)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e1 (149/771492)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003eMean OR (95% CI)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e1.32 (0.54, 3.21)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e2.02 (0.83, 4.93)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e-\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e1.12 (0.46, 2.73)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003e1.36 (0.56, 3.32)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cb\u003e0.39 (0.02, 6.19)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e\u003cb\u003e-\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e\u003cb\u003e1.02 (0.72, 1.43)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e\u003cb\u003e0.73 (0.30, 1.77)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eI2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003eCertainty of Evidence\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003eLow\u003c/b\u003e\u0026oplus;\u0026oplus;\u0026empty;\u0026empty;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003eLow\u003c/b\u003e\u0026oplus;\u0026oplus;\u0026empty;\u0026empty;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e-\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003eLow\u003c/b\u003e\u0026oplus;\u0026oplus;\u0026empty;\u0026empty;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003eLow\u003c/b\u003e\u0026oplus;\u0026oplus;\u0026empty;\u0026empty;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cb\u003eLow\u003c/b\u003e\u0026oplus;\u0026oplus;\u0026empty;\u0026empty;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e\u003cb\u003e-\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e\u003cb\u003eLow\u003c/b\u003e\u0026oplus;\u0026oplus;\u0026empty;\u0026empty;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e\u003cb\u003eLow\u003c/b\u003e\u0026oplus;\u0026oplus;\u0026empty;\u0026empty;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e\u003cb\u003eAll transplant types combined\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNumber of studies (total n SOT/Control)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e8 (16320/2988831)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4 (4065/1139591)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2 (1509/15226)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e8 (13226/1492664)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e7 (15329/3928976)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e6 (15176/3928804)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e2 (4912/379070)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e6 (15185/3928853)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e6 (7436/837748)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003eMean OR (95% CI)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e1.78 (1.01, 3.12)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e1.07 (0.84, 1.36)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e1.62 (1.31, 2.00)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e1.62 (0.94, 2.78)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003e1.32 (1.04, 1.66)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cb\u003e0.94 (0.66, 1.34)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e\u003cb\u003e2.12 (1.38, 3.25)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e\u003cb\u003e1.57 (1.36, 1.80)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e\u003cb\u003e0.84 (0.58, 1.20)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eI2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e93%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e93%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e41%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e43%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e81%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e68%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003eCertainty of Evidence\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003eModerate\u003c/b\u003e\u0026oplus;\u0026oplus;\u0026oplus;\u0026empty;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003eModerate\u003c/b\u003e\u0026oplus;\u0026oplus;\u0026oplus;\u0026empty;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003eModerate\u003c/b\u003e\u0026oplus;\u0026oplus;\u0026oplus;\u0026empty;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003eV. Low\u003c/b\u003e\u0026oplus;\u0026empty;\u0026empty;\u0026empty;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003eModerate\u003c/b\u003e\u0026oplus;\u0026oplus;\u0026oplus;\u0026empty;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cb\u003eModerate\u003c/b\u003e\u0026oplus;\u0026oplus;\u0026oplus;\u0026empty;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e\u003cb\u003eModerate\u003c/b\u003e\u0026oplus;\u0026oplus;\u0026oplus;\u0026empty;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e\u003cb\u003eV. Low\u003c/b\u003e\u0026oplus;\u0026empty;\u0026empty;\u0026empty;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e\u003cb\u003eLow\u003c/b\u003e\u0026oplus;\u0026oplus;\u0026empty;\u0026empty;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"22\" rowspan=\"23\"\u003e\u003cp\u003e\u003cb\u003eTKA only\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e\u003cb\u003eKidney\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNumber of studies (total n SOT/Control)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2 (2346/1740865)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1 (2321/1685295)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1 (2321/1685295)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e1 (2321/1685295)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e2 (6082/7549612)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e1 (2321/1685295)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003eMean OR (95% CI)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e3.18 (1.26, 7.99)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e1.61 (1.14, 2.29)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e-\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e-\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003e1.57 (1.30, 1.89)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cb\u003e0.59 (0.38, 0.93)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e\u003cb\u003e1.42 (1.33, 1.51)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e\u003cb\u003e1.29 (1.04, 1.60)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eI2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e68%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003eCertainty of Evidence\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003eModerate\u003c/b\u003e\u0026oplus;\u0026oplus;\u0026oplus;\u0026empty;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003eModerate\u003c/b\u003e\u0026oplus;\u0026oplus;\u0026oplus;\u0026empty;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e-\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e-\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003eModerate\u003c/b\u003e\u0026oplus;\u0026oplus;\u0026oplus;\u0026empty;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cb\u003eModerate\u003c/b\u003e\u0026oplus;\u0026oplus;\u0026oplus;\u0026empty;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e\u003cb\u003eHigh\u003c/b\u003e\u0026oplus;\u0026oplus;\u0026oplus;\u0026oplus;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e\u003cb\u003eModerate\u003c/b\u003e\u0026oplus;\u0026oplus;\u0026oplus;\u0026empty;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e\u003cb\u003eLiver\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNumber of studies (total n SOT/Control)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1 (772/1685295)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1 (772/1685295)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1 (772/1685295)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e1 (772/1685295)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e2 (2149/7549612)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e1 (772/1685295)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003eMean OR (95% CI)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e2.31 (1.71, 3.11)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e0.45 (0.03, 7.15)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e-\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e-\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003e1.58 (1.15, 2.19)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cb\u003e0.05 (0.00, 0.75)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e\u003cb\u003e1.76 (1.34, 2.31)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e\u003cb\u003e1.54 (1.09, 2.18)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eI2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e87%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003eCertainty of Evidence\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003eModerate\u003c/b\u003e\u0026oplus;\u0026oplus;\u0026oplus;\u0026empty;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003eLow\u003c/b\u003e\u0026oplus;\u0026oplus;\u0026empty;\u0026empty;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e-\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e-\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003eLow\u003c/b\u003e\u0026oplus;\u0026oplus;\u0026empty;\u0026empty;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cb\u003eLow\u003c/b\u003e\u0026oplus;\u0026oplus;\u0026empty;\u0026empty;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e\u003cb\u003eModerate\u003c/b\u003e\u0026oplus;\u0026oplus;\u0026oplus;\u0026empty;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e\u003cb\u003eModerate\u003c/b\u003e\u0026oplus;\u0026oplus;\u0026oplus;\u0026empty;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e\u003cb\u003eLung\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNumber of studies (total n SOT/Control)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1 (129/1685295)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1 (129/1685295)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1 (129/1685295)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e1 (129/1685295)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e1 (129/1685295)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e1 (129/1685295)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003eMean OR (95% CI)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e0.14 (0.01, 2.26)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e0.45 (0.03, 7.15)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e-\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e-\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003e0.11 (0.01, 1.85)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cb\u003e0.28 (0.02, 4.47)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e\u003cb\u003e1.47 (1.06, 2.03)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e\u003cb\u003e0.13 (0.01, 2.08)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eI2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003eCertainty of Evidence\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003eLow\u003c/b\u003e\u0026oplus;\u0026oplus;\u0026empty;\u0026empty;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003eLow\u003c/b\u003e\u0026oplus;\u0026oplus;\u0026empty;\u0026empty;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003e\u003cb\u003e-\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003eLow\u003c/b\u003e\u0026oplus;\u0026oplus;\u0026empty;\u0026empty;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cb\u003eLow\u003c/b\u003e\u0026oplus;\u0026oplus;\u0026empty;\u0026empty;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e\u003cb\u003eLow\u003c/b\u003e\u0026oplus;\u0026oplus;\u0026empty;\u0026empty;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e\u003cb\u003eLow\u003c/b\u003e\u0026oplus;\u0026oplus;\u0026empty;\u0026empty;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e\u003cb\u003eHeart\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNumber of studies (total n SOT/Control)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1 (412/1685295)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1 (412/1685295)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1 (412/1685295)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e1 (412/1685295)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e1 (412/1685295)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e1 (412/1685295)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003eMean OR (95% CI)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e2.16 (1.42, 3.28)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e0.14 (0.01, 2.24)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e-\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e-\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003e1.68 (1.09, 2.58)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cb\u003e0.09 (0.01, 1.40)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e\u003cb\u003e1.19 (0.96, 1.49)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e\u003cb\u003e0.04 (0.00, 0.65)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eI2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003eCertainty of Evidence\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003eModerate\u003c/b\u003e\u0026oplus;\u0026oplus;\u0026oplus;\u0026empty;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003eLow\u003c/b\u003e\u0026oplus;\u0026oplus;\u0026empty;\u0026empty;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e-\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e-\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003eLow\u003c/b\u003e\u0026oplus;\u0026oplus;\u0026empty;\u0026empty;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cb\u003eLow\u003c/b\u003e\u0026oplus;\u0026oplus;\u0026empty;\u0026empty;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e\u003cb\u003eModerate\u003c/b\u003e\u0026oplus;\u0026oplus;\u0026oplus;\u0026empty;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e\u003cb\u003eLow\u003c/b\u003e\u0026oplus;\u0026oplus;\u0026empty;\u0026empty;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e\u003cb\u003ePancreas\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNumber of studies (total n SOT/Control)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1 (167/1685295)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1 (167/1685295)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1 (167/1685295)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e1 (167/1685295)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e1 (167/1685295)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e1 (167/1685295)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003eMean OR (95% CI)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e0.11 (0.01, 1.75)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e2.12 (0.13, 34.05)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e-\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e-\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003e2.10 (1.14, 3.87)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cb\u003e0.21 (0.01, 3.45)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e\u003cb\u003e1.47 (1.06, 2.03)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e\u003cb\u003e0.10 (0.01, 1.60)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eI2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003eCertainty of Evidence\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003eLow\u003c/b\u003e\u0026oplus;\u0026oplus;\u0026empty;\u0026empty;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003eLow\u003c/b\u003e\u0026oplus;\u0026oplus;\u0026empty;\u0026empty;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e-\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e-\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003eModerate\u003c/b\u003e\u0026oplus;\u0026oplus;\u0026oplus;\u0026empty;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cb\u003eLow\u003c/b\u003e\u0026oplus;\u0026oplus;\u0026empty;\u0026empty;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e\u003cb\u003eModerate\u003c/b\u003e\u0026oplus;\u0026oplus;\u0026oplus;\u0026empty;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e\u003cb\u003eLow\u003c/b\u003e\u0026oplus;\u0026oplus;\u0026empty;\u0026empty;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e\u003cb\u003eAll transplant types combined\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNumber of studies (total n SOT/Control)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2 (3359/1740865)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1 (3334/1685295)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e2 (9438/7549612)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e2 (9438/7549612)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e2 (9438/7549612)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e2 (3359/1740865)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003eMean OR (95% CI)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e3.11 (1.16, 8.35)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e1.79 (1.36, 2.36)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e-\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e-\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003e1.56 (1.36, 1.78)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cb\u003e0.89 (0.55, 1.43)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e\u003cb\u003e1.53 (1.35, 1.74)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e\u003cb\u003e1.37 (1.15, 1.63)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eI2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e72%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e73%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e84%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003eCertainty of Evidence\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003eLow\u003c/b\u003e\u0026oplus;\u0026oplus;\u0026empty;\u0026empty;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003eLow\u003c/b\u003e\u0026oplus;\u0026oplus;\u0026empty;\u0026empty;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e-\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e-\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003eModerate\u003c/b\u003e\u0026oplus;\u0026oplus;\u0026oplus;\u0026empty;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cb\u003eLow\u003c/b\u003e\u0026oplus;\u0026oplus;\u0026empty;\u0026empty;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e\u003cb\u003eLow\u003c/b\u003e\u0026oplus;\u0026oplus;\u0026empty;\u0026empty;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e\u003cb\u003eModerate\u003c/b\u003e\u0026oplus;\u0026oplus;\u0026oplus;\u0026empty;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003e3.1 Total hip arthroplasty\u003c/h2\u003e\u003cp\u003eThe meta-analysis results of THA outcomes in SOT patients versus matched controls with their forest plots, pooled ORs and accompanying 95% CI and heterogeneity tests can be seen in Supplementary material.\u003c/p\u003e\u003cdiv id=\"Sec14\" class=\"Section3\"\u003e\u003ch2\u003e3.1.1 Blood Transfusion\u003c/h2\u003e\u003cp\u003ePatients with a SOT (mixed data) had a significantly higher incidence of blood transfusion postoperatively than controls at statistical significance [OR 1.57 (1.36\u0026ndash;1.80), very low certainty]. Liver, lung and heart transplants were also associated with a higher incidence of blood transfusion, at high, moderate and moderate certainty of evidence respectively [OR 1.51 (1.28\u0026ndash;1.77), OR 1.71 (1.29\u0026ndash;2.26), OR 1.57 (1.25\u0026ndash;1.03, 1.52), respectively].\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec15\" class=\"Section3\"\u003e\u003ch2\u003e3.1.2 Periprosthetic Joint Infection\u003c/h2\u003e\u003cp\u003eThose with a SOT (mixed data) had a higher incidence of PJI [OR 1.78 (1.01\u0026ndash;3.12), moderate certainty]. Heart transplants were also associated with a higher incidence of PJI [OR 1.86 (1.19\u0026ndash;2.91), moderate certainty of evidence]. There were no other significant differences between SOT and control in the other SOT subtypes.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec16\" class=\"Section3\"\u003e\u003ch2\u003e3.1.3 Dislocation\u003c/h2\u003e\u003cp\u003eDespite the high OR favouring the control group, the difference between the SOT group (mixed data) and controls was statistically non-significant [OR 1.62, (0.94\u0026ndash;2.78), v. low certainty]. Significant differences were found in those with kidney and heart transplants, favouring the control groups [OR 1.41, (1.16\u0026ndash;1.73), high certainty, and OR 2.17, (1.47\u0026ndash;3.20), moderate certainty].\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec17\" class=\"Section3\"\u003e\u003ch2\u003e3.1.4 Periprosthetic Fracture\u003c/h2\u003e\u003cp\u003ePatients with SOT (mixed data) did not have a higher incidence of sustaining a periprosthetic fracture compared to controls [OR 1.07 (0.84\u0026ndash;1.36), moderate certainty]. This was the case for all subtypes too.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec18\" class=\"Section3\"\u003e\u003ch2\u003e3.1.5 Venous thromboembolism\u003c/h2\u003e\u003cp\u003ePatients with SOT (mixed data) had a significantly higher incidence of DVT but not PE compared to controls [OR 1.32 (1.04\u0026ndash;1.66), OR 0.94 (0.66\u0026ndash;1.34), respectively, both moderate certainty]. Kindey and heart transplants were associated with a higher incidence of DVT compared to controls [OR 1.60 (1.30\u0026ndash;1.97), high certainty, OR 2.33 (1.54\u0026ndash;3.51), moderate certainty, respectively] and lung transplants with a higher incidence of PE [OR 3.02 (1.24\u0026ndash;7.34), moderate certainty].\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec19\" class=\"Section3\"\u003e\u003ch2\u003e3.1.6 Hospital re-admission\u003c/h2\u003e\u003cp\u003ePatients with a SOT (mixed data) had a significantly higher incidence of being re-admitted to hospital within 30 days of their THA compared to controls [OR 1.62 (1.31\u0026ndash;2.00), moderate certainty]. There were no data for SOT subtype analyses.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec20\" class=\"Section3\"\u003e\u003ch2\u003e3.1.7 Mortality\u003c/h2\u003e\u003cp\u003ePatients with a SOT (mixed data) had a higher incidence of early mortality (up to 90 days) compared to controls [OR 2.12 (1.38\u0026ndash;3.25), moderate certainty]. Kidney transplant patients undergoing THA had a higher incidence of 5-year mortality compared to controls in a single study [OR 2.8 (1.8\u0026ndash;4.2), moderate certainty].\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec21\" class=\"Section3\"\u003e\u003ch2\u003e3.1.8 All-cause revision\u003c/h2\u003e\u003cp\u003ePatients with a SOT (mixed data) did not have a higher incidence of all-cause revision compared to controls [OR 0.84 (0.58, 1.20), low certainty]. Among all subtypes, only kidney transplants were associated with a higher risk of all-cause revision [OR 1.30 (1.05\u0026ndash;1.61), high certainty].\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv id=\"Sec22\" class=\"Section2\"\u003e\u003ch2\u003e3.2 Total knee arthroplasty\u003c/h2\u003e\u003cp\u003eThe meta-analysis results of TKA outcomes in SOT patients versus matched controls with their forest plots, pooled ORs and accompanying 95% CI and heterogeneity tests can be seen in Supplementary material.\u003c/p\u003e\u003cdiv id=\"Sec23\" class=\"Section3\"\u003e\u003ch2\u003e3.2.1 Blood Transfusion\u003c/h2\u003e\u003cp\u003ePatients with a SOT (mixed data) had a significantly higher incidence of blood transfusion postoperatively than controls at statistical significance [OR 1.37 (1.15\u0026ndash;1.63), moderate certainty]. Among SOT subtypes, kidney and liver transplants were also associated with a higher risk [OR 1.29 (1.04\u0026ndash;1.60), moderate certainty, and OR 1.54 (1.09\u0026ndash;2.18), low certainty].\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec24\" class=\"Section3\"\u003e\u003ch2\u003e3.2.2 Periprosthetic Joint Infection\u003c/h2\u003e\u003cp\u003eThose with a SOT (mixed data) had a significantly higher incidence of PJI compared to controls [OR 3.11 (1.16\u0026ndash;8.35), low certainty]. There were also significant differences in the kidney, liver and heart subgroups [OR 3.18 (1.26\u0026ndash;7.99), OR 2.31 (1.71\u0026ndash;3.11), and OR 2.16 (1.42\u0026ndash;3.28), respectively, all moderate certainty].\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec25\" class=\"Section3\"\u003e\u003ch2\u003e3.2.3 Periprosthetic Fracture\u003c/h2\u003e\u003cp\u003ePatients with a SOT (mixed data) had a significantly higher incidence of sustaining a periprosthetic fracture compared to controls [OR 1.79 (1.36\u0026ndash;2.36), low certainty]. Among SOT subtypes, those with a kidney transplant were at higher risk of a periprosthetic fracture compared to controls [OR 1.61 (1.14\u0026ndash;2.29), moderate certainty].\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec26\" class=\"Section3\"\u003e\u003ch2\u003e3.2.4 Venous thromboembolism\u003c/h2\u003e\u003cp\u003ePatients with a SOT (mixed data) had a significantly higher incidence of DVT but not PE compared to controls [OR 1.56 (1.36\u0026ndash;1.78), moderate certainty, and OR 0.89 (0.55\u0026ndash;1.43), low certainty, respectively]. Kindey, liver, heart and pancreas transplants were also associated with a higher incidence of DVT [OR 1.57 (1.30\u0026ndash;1.89), moderate certainty, OR 1.58 (1.15\u0026ndash;2.19), low certainty, OR 1.68 (1.09\u0026ndash;2.58), low certainty, and OR 2.10 (1.14, 3.87), moderate certainty, respectively]. No SOT subtypes were associated with a higher incidence of PE.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec27\" class=\"Section3\"\u003e\u003ch2\u003e3.2.5 All-cause revision\u003c/h2\u003e\u003cp\u003eThere was a higher incidence of all-cause revision in those with a SOT (mixed data) compared to controls [OR 1.37 (1.15\u0026ndash;1.63, moderate certainty]. A significantly higher incidence was also observed with kidney and liver transplants [OR 1.29 (1.04\u0026ndash;1.60, and OR 1.54 (1.09, 2.18), respectively, both moderate certainty).\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"4 DISCUSSION","content":"\u003cp\u003eThe purpose of our study was to quantify the perioperative risks of complications in those with SOT with the ultimate objective to inform surgeons and patients, help with decision-making and guide the process of obtaining informed consent. We pooled the results of all SOTs together for all outcomes but also performed subgroup analyses for each subtype SOT. For the majority of outcomes, SOTs were associated with unfavourable ORs compared to controls but the certainty of evidence of each individual result ranged from very low to high. As part of the GRADE tool, this was mostly influenced by the magnitude of effect, width of the confidence intervals, clinical and statistical heterogeneity. We would advise the reader to interpret results based on low and very low certainty of evidence with caution. Our findings suggest a significantly higher incidence of blood transfusion, DVT, PJI and all-cause revision after either THA or TKA in SOT patients compared to the general population. Early postoperative mortality and 30-day re-admission rates were higher after THA in kidney transplant patients compared to controls and periprosthetic fracture incidence was higher in SOT patients undergoing TKA compared to controls.\u003c/p\u003e\u003cp\u003e Our results are primarily based on the large database studies included in our review. For TKA in SOT patients, Klika et al. compared 6104 SOT patients with 5,870,421 controls and found an increased length of stay by almost half a day, 43% higher incidence of any complication and were more likely to need a blood transfusion [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Similarly, Klement et al. compared 3339 SOT patients with 1,685,295 controls and found that the higher complication incidence in the SOT group occurred in the first 90 days mostly[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. The SOT group had a higher incidence of PJI, periprosthetic fracture and revision. Their subgroups with lung and heart transplants had the fewest complications, which is in agreement with another study that found that kidney transplants are associated with higher complications compared to non-kidney SOTs[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. For THA, Varatharaj et al. found a significantly higher incidence of complications in the SOT group in a database study of 367,894 patients, including anaemia, acute kidney injury, blood transfusion, dislocation and PJI[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Klement et al. was in agreement with these findings, reporting a higher incidence of medical complications, dislocations, PJI and need for irrigation and debridement in the SOT group, with the kidney transplant subgroup carrying the worst complication profile[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Lung and pancreas transplants were not associated with a higher incidence of surgical complications compared to controls.\u003c/p\u003e\u003cp\u003eThe clinical outcomes of THA and TKA are also an important consideration. The limited existing literature appears to be in agreement about the good efficacy of both THA and TKA with regard to meaningful improvements in functional, pain and quality of life scores [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan additionalcitationids=\"CR28\" citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. However, these good outcomes come at an expense of higher incidence of complications as well as higher healthcare costs, extended hospital stays and readmissions[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. The incidence of early mortality is also higher in SOT patients compared to the general population, as shown in our study. Two studies with mixed THA and TKA data found no differences in mortality in liver transplant patients compared to controls (OR 0.7 and 1.2) and another one in kidney transplant patients also found a similar incidence of mortality at one year in those undergoing THA or TKA compared to those that did not undergo surgery [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. However, a study also reporting mixed THA and TKA data that included all types of SOTs found a significantly higher incidence of death in those with any SOT type undergoing total joint arthroplasty compared to the general population (OR 7.42), however the deaths occurred at an average of 3.83 years post-operatively, therefore it is not possible to make conclusions on causality as early mortality rates are not reported[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe existing evidence on implant survival in SOT patients is scarce. In the study by Chalmers et al., two-year and 5-year survival were 94% and 92%, respectively, which are similar to those reported by Wu et al. that included both THA and TKA patients (96% on-year, 94% 4-year survival)[\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. Similar survivorship was reported in TKA, with survival rates of 98% at 2 years and 93% at 5 years having been described by Ledford et al.[\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. Whilst these figures are acceptable for a high-risk population, they are significantly lower than the survival rates of the general population, which are around 98.5% and 97.2% for THA and 97.6% and 96.1% for TKA at 5 and 10 years, respectively, according to the most recently published National Joint Registry report[\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. This is consistent with the findings of the present study demonstrating a higher incidence of all-cause revision in SOT patients undergoing THA and TKA compared to controls; this should be clearly communicated to the patient by the surgeon, highlighting the challenges associated with a potential revision procedure with regard to both surgical complexity as well as complication risks.\u003c/p\u003e\u003cp\u003eDespite the higher complication profile of THA and TKA in SOT patients compared to the general population, the improved clinical outcomes reported in the existing literature should be strongly considered. Decisions should be made on an individual basis considering several factors such as frailty, influence of arthritis on quality of life, severity of pain, baseline mobility and other comorbidities, and should be made mutually by surgeon and patient after a rigorous informed consent process. Anaesthetic and general medical involvement should be sought in decision-making and pre-operative patient optimisation to minimise the risk of complications as much as possible.\u003c/p\u003e\u003cp\u003eOur study has limitations, which are mostly secondary to the inherent drawbacks of the included evidence. All included studies are retrospective reviews which included heterogeneous outcomes and procedures with different implants and postoperative care; however the quality of the majority of them was found to be good at our study quality assessment. More than half of the included studies did not match their exposure group to control patients with propensity score matching which introduces risk of bias and finally, retrospective database studies rely on data having been recorded appropriately and they often suffer from coding/indexing inconsistencies which may influence their results.\u003c/p\u003e"},{"header":"5 CONCLUSION","content":"\u003cp\u003eWe have found increased incidence of blood transfusion, PJI, DVT and all-cause revision after either a THA or TKA in SOT patients compared to the general population. We have quantified these risks in the present study and have assigned a certainty of evidence for each reported result. Decisions should be made on an individual basis in a multidisciplinary approach and after the risks and benefits of the procedure are explained to the patient in detail.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eConflicts of interest\u003c/span\u003e:\u003c/strong\u003e\u003cp\u003eNone of the authors have any conflicts of interest to declare\u003c/p\u003e\u003c/p\u003e\u003ch2\u003eFunding:\u003c/h2\u003e\u003cp\u003eMRC Grant MR/X036766/1.\u003c/p\u003e\u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eHuman Ethics and Consent to Participate\u003c/span\u003e: not applicable\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eDC Conceptualisation, meta-analyses, certainty of evidence assessments, coordination and authoring manuscript, RR/ER/AP/AA data collection and study quality assessment, NM/BJ general supervision, final editing of manuscript. All authors approved the final version of the manuscript prior to submission.\u003c/p\u003e\u003ch2\u003eAcknowledgments:\u003c/h2\u003e\u003cp\u003enone\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eData is provided within the manuscript or supplementary information files\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eBrown N, Ralles S, Kroin E, Adams W, Wu K. Complications of total joint arthroplasty in solid organ transplant patients versus a large control group. J Clin Orthop Trauma. 2020;11(1):91\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eIsrani AK, Zaun D, Hadley N, Rosendale JD, Schaffhausen C, McKinney W, et al. Am J Transpl Off J Am Soc Transpl Am Soc Transpl Surg. 2020;20(Suppl s):509\u0026ndash;41. OPTN/SRTR 2018 Annual Data Report: Deceased Organ Donation.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMarston SB, Gillingham K, Bailey RF, Cheng EY. 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Arthroplasty Today. 2022;14:6\u0026ndash;13.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePatel AV, Stevens AJ, White R, Aravindan S, Barry LW, Rauck RC. Hip, knee, and shoulder arthroplasty in patients with a history of solid organ transplant: A review. J Orthop. 2024;51:116\u0026ndash;21.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWu CJ, Brekke AC, Hinton ZW, Kim BI, Ryan SP, Bolognesi MP, et al. Total joint arthroplasty following solid organ transplants: complications and mid-term outcomes. Int Orthop. 2022;46(12):2735\u0026ndash;45.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eChalmers BP, Ledford CK, Statz JM, Perry KI, Mabry TM, Hanssen AD, et al. Survivorship After Primary Total Hip Arthroplasty in Solid-Organ Transplant Patients. J Arthroplasty. 2016;31(11):2525\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLedford CK, Chalmers BP, Statz JM, Perry KI, Mabry TM, Hanssen AD, et al. Primary Total Knee Arthroplasty After Solid Organ Transplant: Survivorship and Complications. J Arthroplasty. 2017;32(1):101\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNational Joint Registry - Annual Report. 2024 [Internet]. The National Joint Registry. 2024 [cited 2025 Jul 16]. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.njrcentre.org.uk/national-joint-registry-annual-report-2024/\u003c/span\u003e\u003cspan address=\"https://www.njrcentre.org.uk/national-joint-registry-annual-report-2024/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"arthroplasty","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [Arthroplasty](https://link.springer.com/journal/42836)","snPcode":"42836","submissionUrl":"https://submission.springernature.com/new-submission/42836/3","title":"Arthroplasty","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Open","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"joint replacement, renal transplant, revision, infection, complications","lastPublishedDoi":"10.21203/rs.3.rs-7185982/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7185982/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eThe aim of this systematic review and meta-analysis was to quantify risks of complications associated with total hip and knee arthroplasty (THA, TKA) in patients with solid organ transplants (SOT) compared to the general population.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e: The study was pre-registered on PROSPERO (CRD42023399043). Literature searches were performed looking for comparative studies reporting postoperative complication data of THA or TKA in patients with kidney, liver, pancreas, heart or lung transplants versus controls. Outcomes of interest included incidence of blood transfusion, periprosthetic joint infection (PJI), periprosthetic fracture, deep venous thrombosis (DVT), pulmonary embolism (PE), mortality, hospital re-admission and all-cause revision. The Newcastle Ottawa scale was used to assess study quality and the GRADE for certainty of evidence.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e: A total of 13 studies participated in meta-analyses (10 in THA, 3 in TKA). Compared to controls, SOT patients (mixed data from all transplant types) had a significantly higher incidence of blood transfusion [THA OR 1.57 (1.36–1.80), TKA OR 1.37 (1.15–1.63)], PJI [THA OR 1.78 (1.01–3.12), TKA 3.11 (1.16–8.35)], DVT [THA OR 1.32 (1.04–1.66), TKA OR 1.56 (1.36–1.78)], and all-cause revision [only TKA OR 1.37 (1.15-1.63)]. THA in kidney transplant patients was associated with higher early mortality [OR 2.12 (1.38-3.25)] and 30-day re-admission [OR 1.62 (1.31-2.00)] compared to the general population. SOT were not associated with a higher incidence of post-operative PE after either THA or TKA [OR 0.94 (0.66-1.34), OR 0.89 (0.55-1.43), respectively]. The incidence of THA dislocation in mixed analyses with all SOT types was not statistically significant despite the unfavourable OR [1.62 (0.94-2.78)] but it was in the kindey and heart transplant subgroup analyses (OR 1.41 (1.16-1.73), OR 2.17 (1.47-3.20), respectively. The incidence of periprosthetic fracture was not higher in SOT patients compared to controls in those undergoing a THA [OR 1.07 (0.84-1.36)], but it was after a TKA [OR 1.79 (1.36-2.36)].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e THA and TKA is associated with an unfavourable complication profile in SOT patients compared to the general population. Decisions for or against arthroplasty surgery should be made on an individual basis with a multidisciplinary approach.\u003c/p\u003e","manuscriptTitle":"Complications of total hip and knee arthroplasty in solid organ transplant patients: a systematic review and meta-analysis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-02 06:09:19","doi":"10.21203/rs.3.rs-7185982/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-09-01T09:51:35+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-30T20:37:36+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-28T14:23:42+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"161826053317726579134733468330148801918","date":"2025-08-27T09:35:00+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"2849776808463341232324023253918666769","date":"2025-08-25T12:00:33+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-08-25T09:16:50+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-07-24T06:17:05+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-07-24T06:16:30+00:00","index":"","fulltext":""},{"type":"submitted","content":"Arthroplasty","date":"2025-07-22T10:33:22+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"arthroplasty","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [Arthroplasty](https://link.springer.com/journal/42836)","snPcode":"42836","submissionUrl":"https://submission.springernature.com/new-submission/42836/3","title":"Arthroplasty","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Open","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"0d00e43d-2b30-4080-a338-ab5badacac1a","owner":[],"postedDate":"September 2nd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-10-06T16:38:14+00:00","versionOfRecord":[],"versionCreatedAt":"2025-09-02 06:09:19","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7185982","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7185982","identity":"rs-7185982","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}