*Purpose: Improvements in postoperative care for renal transplant patients has increased both the duration and quality of life for patients. These patients are now able to successfully undergo elective surgery which was previously impossible due to their underlying health conditions. Few studies have examined the surgical outcomes of renal transplant patients among the various surgical sub-specialties, and particularly spine surgery.

*Methods: The National Inpatient Sample from 2008-2014 data base was used. All patients included meet the following criteria: ≥18 years old, previous spinal fusion surgery, exploration/decompression, and/or spinal refusion/revision. Once patients were identified, patients were further stratified based on transplant history with kidney transplant (KTX) patients in Group A and non-kidney transplant (NKTX) patients in Group B.

*Results: 579,726 patients met inclusion criteria with 685 (0.1%) having a history of previous renal transplant (Group A). Group A was significantly older and more likely to be male compared to group B (60.1 vs 56.6, p<.001 and 58% vs 45.5%, p<.001, respectively). Group A experienced higher overall rates of complication( 29.8% vs 18.9%, p<.001) compared to Group B with acute post hemorrhagic anemia and need for RBC transfusion being significantly higher for Group A vs Group B (15.8% vs 9.1%, p<.001 and 13.6% vs 6.2%, p<.001, respectively). The rate of urinary and cardiac complications were also higher in Group A compared with Group B (1.9% vs .6% p=0.000 and 1.5% vs 0.6%, p=.002). Multivariable analysis revealed that Group A were more likely to experience a greater length of stay (1.23 (0.94-1.53), p=.001), lower routine discharge (0.57 (0.48-0.69), p<.001), and higher discharge to alternative care facilities (1.91 (1.57-2.33), p<.001).

*Conclusions: Patients with a previous history of kidney transplant have worse outcomes. This study establishes the degree to which this is true, identifying the complex risk factors and specific complications which play a role in observed differences between these groups. As spinal fusion surgeries increase in frequency and as care of renal transplant patients improves, understanding the implications and expected outcomes of each operation is central to providing effective multi-disciplinary care.

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