SOT recipients are commonly prescribed immunosuppressive therapies which may predispose patients to higher infection and complication rates following total shoulder arthroplasty. This article aims to analyze the effects SOT and subsequent immunosuppressive regimens have on the functional and patient reported outcomes of total shoulder arthroplasties. A single institution, multi-surgeon retrospective case-control study investigating the functional and patient reported outcomes of shoulder arthroplasty after SOT was conducted between the years of 2010-2020. To be included in the study, patients must have undergone SOT prior to primary total shoulder arthroplasty. A 4:1 match-paired control group lacking SOT prior to arthroplasty was then constructed. Thirty-four SOT patients (18 males and 16 females) and 136 control patients (77 male and 59 female) were included in the study. Patients were analyzed who underwent SOT prior to shoulder arthroplasty, with outcomes compared to controls who only underwent arthroplasty. The primary outcomes include range of motion (ROM) and strength in forward elevation, external rotation, and internal rotation, and patient reported outcomes. There was no significant difference in improvement for range of motion and strength between the two cohorts, but within each cohort, improvement was statistically significant. In the SOT patients, forward elevation improved by 56o ± 52o, external rotation increased 13o ± 20o, and internal rotation increased by two vertebral levels. In the non-SOT patients, forward elevation improved 45o ± 51o, external rotation increased 16o ± 25o, and internal rotation increased by three vertebral levels. SOT patients had equivocal VAS pain and Simple Shoulder Test scores but lower ASES (59 ± 13 vs 79 ± 2; p=0.002) and SANE (61 ± 30 vs 84 ± 17; p<.001) scores than non-SOT patients. Complication rates were significantly higher in the SOT group (15% vs 6%; p=0.05), but incidence of surgical revisions was not significantly different (SOT = 3%; non-SOT = 5%; p=0.59). Shoulder arthroplasty is a safe, effective surgical intervention for improving shoulder function in patients with a history of SOT. Despite being on chronic immunosuppressive regimens, our solid organ transplants had comparable clinical outcomes and revision rates, but higher complication rates.