Predictors for Development of Chronic Rhinosinusitis in Transplant Recipients

Abstract

Objectives

Studies suggest that transplant patients are at a higher risk of developing chronic rhinosinusitis (CRS). However, there is a dearth of studies describing the factors that may be linked to the development of CRS in this population. Our objective is to identify the risk factors associated with the development of CRS in transplant recipients.

Study design

Retrospective cohort.

Setting

Tertiary care center.

Methods

This cohort included 3347 transplant recipients seen between 2017 and 2022. Of these, 2128 patients met the inclusion criteria and were grouped according to whether they were diagnosed with CRS during the post-transplant period. The analysis included both univariate and multivariate analysis to ascertain the odds ratio (OR) and predictive factors.

Results

Of the 2128 patients, 649/2128 (30.4%) had CRS. CRS patients had an increased prevalence of previous endoscopic sinus surgery, allergic rhinitis, and recurrent acute rhinosinusitis in the pre-transplant period compared to the non-CRS group. According to the multivariate analysis, patients with primary immunodeficiency and additional transplant were 1.9 and 3.1 times more likely to develop CRS during the posttransplant period (95% CI: 1.3–2.6, p < .0001), (95% CI: 1.3 −7.3, p = .01), respectively. Sirolimus use was also associated with the development of CRS (OR = 1.4, 95% CI: 1.1–1.9, p = .01).

Conclusion

This study is the largest cohort aimed at determining the predictive factors associated with the development of CRS. Patients with pretransplant rhinologic conditions, hematologic deficiencies, and the utilization of specific immunosuppressants were found to have a higher likelihood of developing CRS following transplantation.

Keywords

sinusitis chronic rhinosinusitis transplant recipients nonsolid organ transplant rhinosinusitis solid organ transplant

Get full access to this article

View all access options for this article.

References

Bhattacharyya

. Contemporary assessment of the disease burden of sinusitis. Am J Rhinol Allergy. 2009;23(4):392–395.

Blackwell

Lucas

Clarke

. Summary health statistics for U.S. adults: National health interview survey, 2012. Vital Health Stat. 2014;10(260):1–161.

Dugar

Lander

Mahalingam-Dhingra

Shah

. Pediatric acute sinusitis: Predictors of increased resource utilization. Laryngoscope. 2010;120(11):2313–2321.

Pandrangi

Reiter

. The burden of sinusitis in hematologic transplant patients: A national perspective. Laryngoscope. 2018;128(12):2688–2692.

Orlandi

Kingdom

Smith

, et al. International consensus statement on allergy and rhinology: Rhinosinusitis 2021. Int Forum Allergy Rhinol. 2021;11(3):213–739.

Valera

do Lago

Tamashiro

, et al. Prognosis of acute invasive fungal rhinosinusitis related to underlying disease. Int J Infect Dis IJID Off Publ Int Soc Infect Dis. 2011;15(12):e841–e844.

Silveira

MLC

Anselmo-Lima

Faria

, et al. Impact of early detection of acute invasive fungal rhinosinusitis in immunocompromised patients. BMC Infect Dis. 2019;19(1):310.

Fernandez

Crocetta

Demattè

, et al. Acute invasive fungal rhinosinusitis in immunocompromised patients: Role of an early diagnosis. Otolaryngol Head Neck Surg Off J Am Acad Otolaryngol-Head Neck Surg. 2018;159(2):386–393.

Biswas

Al-Amin

Razib

Mahbub

. Acute invasive fungal Rhinosinusitis: Our experience in immunocompromised host. Mymensingh Med J MMJ. 2013;22(4):814–819.

10.

Savage

Taylor

Blackwell

, et al. Paranasal sinusitis following allogeneic bone marrow transplant. Bone Marrow Transplant. 1997;19(1):55–59.

11.

Won

Y-W

Jang

, et al. Retrospective analysis of paranasal sinusitis in patients receiving hematopoietic stem cell transplantation. Int J Hematol. 2011;93(3):383–388. doi: https://doi.org/10.1007/s12185-011-0797-8.

12.

Candelo

Darakjian

Avila-Castano

Donaldson

. Risk factors for recalcitrant chronic rhinosinusitis in non-solid and solid transplant recipients. Am J Rhinol Allergy. 2023;37(5):550–557. doi: https://doi.org/10.1177/19458924231177855.

13.

Candelo

Avila-Castano

Verez

Abello-Vaamonde

Donaldson

. Risk factors for recalcitrant chronic rhinosinusitis in organ transplant recipients. Otolaryngol Head Neck Surg Off J Am Acad Otolaryngol-Head Neck Surg. 2023;168(5):1217–1227. doi: https://doi.org/10.1002/ohn.236.

14.

Drozd-Sokolowska

Sokolowski

Wiktor-Jedrzejczak

Niemczyk

. Sinusitis in patients undergoing allogeneic bone marrow transplantation – a review. Braz J Otorhinolaryngol. 2016;83(1):105–111. doi: https://doi.org/10.1016/j.bjorl.2016.02.012.

15.

Pandrangi

Reiter

. The burden of sinusitis in hematologic transplant patients: A national perspective. Laryngoscope. 2018;128(12):2688–2692. doi: https://doi.org/10.1002/lary.27363.

16.

Ryu

Seo

Lee

, et al. Clinical course of rhinosinusitis and efficacy of sinonasal evaluation in kidney transplant recipients: Review of 1589 patients. Eur Arch Oto-Rhino-Laryngol Off J Eur Fed Oto-Rhino-Laryngol Soc EUFOS Affil Ger Soc Oto-Rhino-Laryngol - Head Neck Surg. 2018;275(5):1183–1188. doi: https://doi.org/10.1007/s00405-018-4941-4.

17.

Spillinger

Low

Smith

Stokken

O'Brien

Choby

. Presentation and outcomes of chronic rhinosinusitis following liver and kidney transplant. World J Otorhinolaryngol - Head Neck Surg. 2020;7(2):139–145. doi: https://doi.org/10.1016/j.wjorl.2020.05.001.

18.

Tzelnick

Soudry

. Rhinosinusitis in solid organ transplant recipients: Analysis of 4562 transplanted patients. Am J Rhinol Allergy. 2019;33(1):56–61. doi: https://doi.org/10.1177/1945892418808717.

19.

Savage

Taylor

Blackwell

, et al. Paranasal sinusitis following allogeneic bone marrow transplant. Bone Marrow Transplant. 1997;19(1):55–59. doi: https://doi.org/10.1038/sj.bmt.1700601.

20.

Kim

. Incidence and treatment outcome of rhinosinusitis before kidney transplantation: A retrospective cohort study. J Pers Med. 2021;11(6):553. doi: https://doi.org/10.3390/jpm11060553.

21.

Ortiz

Sakano

De Souza

Vigorito

Eid

KAB

. Chronic GVHD: Predictive factor for rhinosinusitis in bone marrow transplantation. Braz J Otorhinolaryngol. 2006;72(3):328–332. doi: https://doi.org/10.1016/s1808-8694(15)30964-2.

22.

Bento

Ortiz

Nicola

EMD

Vigorito

Sakano

. Sinonasal disorders in hematopoietic stem cell transplantation. Braz J Otorhinolaryngol. 2014;80(4):285–289. doi: https://doi.org/10.1016/j.bjorl.2014.05.009.

23.

DeConde

Soler

. Chronic rhinosinusitis: Epidemiology and burden of disease. Am J Rhinol Allergy. 2016;30(2):134–139. doi: https://doi.org/10.2500/ajra.2016.30.4297.

24.

Hastan

Fokkens

Bachert

, et al. Chronic rhinosinusitis in Europe—An underestimated disease. A GA²LEN study. Allergy. 2011;66(6):1216–1223. doi: https://doi.org/10.1111/j.1398-9995.2011.02646.x.

25.

Dietz de Loos

Lourijsen

Wildeman

MAM

, et al. Prevalence of chronic rhinosinusitis in the general population based on sinus radiology and symptomatology. J Allergy Clin Immunol. 2019;143(3):1207–1214. doi: https://doi.org/10.1016/j.jaci.2018.12.986.

26.

Beule

. Epidemiology of chronic rhinosinusitis, selected risk factors, comorbidities, and economic burden. GMS Curr Top Otorhinolaryngol Head Neck Surg. 2015;14:Doc11. doi: https://doi.org/10.3205/cto000126.

27.

Samitas

Carter

Kariyawasam

Xanthou

. Upper and lower airway remodelling mechanisms in asthma, allergic rhinitis and chronic rhinosinusitis: The one airway concept revisited. Allergy. 2018;73(3):993–1002. doi: https://doi.org/10.1111/all.13373.

28.

Ryu

Min

Park

Choi

J-H

. Bidirectional association between asthma and chronic rhinosinusitis: Two longitudinal follow-up studies using a national sample cohort. Sci Rep. 2020;10(1):9589. doi: https://doi.org/10.1111/all.13373.

29.

Helman

Barrow

Edwards

, et al. The role of allergic rhinitis in chronic rhinosinusitis. Immunol Allergy Clin North Am. 2020;40(2):201–214. doi: https://doi.org/10.1016/j.iac.2019.12.010.

30.

Khan

Vandeplas

Huynh

TMT

, et al. The Global Allergy and Asthma European Network (GALEN) rhinosinusitis cohort: A large European cross-sectional study of chronic rhinosinusitis patients with and without nasal polyps. Rhinology. 2019;57(1):32–42. doi: https://doi.org/10.4193/Rhin17.255.

31.

Moeller

Martin

Welch

. Sinonasal evaluation preceding hematopoietic transplantation. Otolaryngol Neck Surg. 2011;144(5):796–801. doi: https://doi.org/10.1177/0194599810395089.

32.

Sokołowski

Drozd-Sokołowska

Kobylińska

, et al. Impact of pre-transplantation sinus abnormalities assessed by Lund-Mackay scoring system on sinusitis occurrence after allogeneic hematopoietic cell transplantation in acute leukemia patients. Folia Med Cracov. 2021;61(1):109–120.

33.

Lee

Yip

Jamal

Lee

. Impact of septal deviation on recurrent chronic rhinosinusitis after primary surgery: A matched case-control study. Otolaryngol Head Neck Surg Off J Am Acad Otolaryngol-Head Neck Surg. 2019;160(5):922–927. doi: https://doi.org/10.1177/0194599818815106.

34.

Styczyński

Tridello

Koster

, et al. Death after hematopoietic stem cell transplantation: Changes over calendar year time, infections and associated factors. Bone Marrow Transplant. 2020;55:126–136.

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.61 MB