Immunosuppressed organ transplant recipients experience higher rates of medically refractory chronic rhinosinusitis (CRS) requiring endoscopic sinus surgery (ESS).
Objective
To better understand the pathogenesis of CRS in immunosuppressed organ transplant recipients to aid in developing effective treatment protocols.
Methods
Structured histopathology (SHP) reports of sinonasal mucosa were obtained for 27 transplant and 505 nontransplant patients with CRS undergoing ESS. SHP reports were compared to identify differences in the inflammatory environment between the 2 groups.
Results
SHP analysis revealed significantly higher rates of neutrophil infiltrate (48.1% vs 10.7%, P < .001), basement membrane thickening (74.1% vs 30.9%, P < .001), subepithelial edema (85.2% vs 25.7%, P < .001), and fibrosis (37.0% vs 16.8%, P = .008) in the sinus tissue of transplant patients compared to nontransplant patients, respectively.
Conclusion
CRS patients with a history of organ transplant overall displayed higher tissue neutrophilia and extensive tissue modeling on SHP. This patient population could potentially benefit from treatment modalities that are comparable to those used in patients with non-type 2 CRS.
BerlingerNT. Sinusitis in immunodeficient and immunosuppressed patients. Laryngoscope. 1985;95(1):29–33. doi:10.1288/00005537-198501000-00009
3.
SavageDGTaylorPBlackwellJ, et al.Paranasal sinusitis following allogeneic bone marrow transplant. Bone Marrow Transplant. 1997;19(1):55–59. doi:10.1038/sj.bmt.1700601
4.
LalDSciannaJMStankiewiczJA. Efficacy of targeted medical therapy in chronic rhinosinusitis, and predictors of failure. Am J Rhinol Allergy. 2009;23(4):396–400. doi:10.2500/ajra.2009.23.3334
5.
YoungLCStowNWZhouLDouglasRG. Efficacy of medical therapy in treatment of chronic rhinosinusitis. Allergy Rhinol (Providence). 2012;3(1):e8–e12. doi:10.2500/ar.2012.3.0027
6.
CandeloEAvila-CastanoKVerezAAbello-VaamondeJADonaldsonAM. Risk factors for recalcitrant chronic rhinosinusitis in organ transplant recipients. Otolaryngol Head Neck Surg. 2023;168(5):1217–1227. doi:10.1002/ohn.236
7.
CandeloEBohorquez-CaballeroADAvila-CastanoKMercadoLADonaldsonA. Predictors for development of chronic rhinosinusitis in transplant recipients. Am J Rhinol Allergy. 2024;38(6):373–383. doi:10.1177/19458924241272990
8.
TzelnickSSoudryE. Rhinosinusitis in solid organ transplant recipients: analysis of 4562 transplanted patients. Am J Rhinol Allergy. 2019;33(1):56–61. doi:10.1177/1945892418808717
9.
PatelZM. Practice patterns regarding noninvasive rhinosinusitis in the immunosuppressed patient population. Allergy Rhinol (Providence). 2013;4(3):e151–e154. doi:10.2500/ar.2013.4.0070
10.
DaoAMRereddySKWiseSKDelGaudioJMPatelZM. Management of non-invasive rhinosinusitis in the immunosuppressed patient population. Laryngoscope. 2015;125(8):1767–1771. doi:10.1002/lary.25305
11.
SnidvongsKLamMSacksR, et al.Structured histopathology profiling of chronic rhinosinusitis in routine practice. Int Forum Allergy Rhinol. 2012;2(5):376–385. doi:10.1002/alr.21032
12.
SimpsonTTalatiVBairdAM, et al.Histopathology of allergic fungal rhinosinusitis versus chronic rhinosinusitis with nasal polyps. Laryngoscope. 2024;134(6):2617–2621. doi:10.1002/lary.31225
13.
TalatiVBairdAMGattusoP, et al.Histopathology of recalcitrant maxillary sinusitis necessitating endoscopic medial maxillectomy. Laryngoscope. 2024;134(6):2646–2652. doi:10.1002/lary.31262
14.
KuharHNTajudeenBAMahdaviniaMGattusoPGhaiRBatraPS. Inflammatory infiltrate and mucosal remodeling in chronic rhinosinusitis with and without polyps: structured histopathologic analysis. Int Forum Allergy Rhinol. 2017;7(7):679–689. doi:10.1002/alr.21943
15.
RamanAPapagiannopoulosPKuharHNGattusoPBatraPSTajudeenBA. Histopathologic features of chronic sinusitis precipitated by odontogenic infection. Am J Rhinol Allergy. 2019;33(2):113–120. doi:10.1177/1945892418811210
16.
TajudeenBAGantiAKuharHN, et al.The presence of eosinophil aggregates correlates with increased postoperative prednisone requirement. Laryngoscope. 2019;129(4):794–799. doi:10.1002/lary.27693
17.
PapagiannopoulosPKuharHNRamanA, et al.Understanding the propensity for chronic sinusitis in patients on immunosuppressive therapy. Am J Rhinol Allergy. 2018;32(6):478–484. doi:10.1177/1945892418793522
18.
OrlandiRRKingdomTTSmithTL, et al.International consensus statement on allergy and rhinology: rhinosinusitis 2021. Int Forum Allergy Rhinol. 2021;11(3):213–739. doi:10.1002/alr.22741
19.
FokkensWJLundVJHopkinsC, et al.European position paper on rhinosinusitis and nasal polyps 2020. Rhinology. 2020;58(Suppl S29):1–464. doi:10.4193/Rhin20.401
20.
XieXXuanLZhaoYWangXZhangL. Diverse endotypes of chronic rhinosinusitis and clinical implications. Clin Rev Allergy Immunol. 2023;65(3):420–432. doi:10.1007/s12016-023-08976-y
21.
KatoAPetersATStevensWWSchleimerRPTanBKKernRC. Endotypes of chronic rhinosinusitis: relationships to disease phenotypes, pathogenesis, clinical findings, and treatment approaches. Allergy. 2022;77(3):812–826. doi:10.1111/all.15074
22.
StevensWWPetersATTanBK, et al.Associations between inflammatory endotypes and clinical presentations in chronic rhinosinusitis. J Allergy Clin Immunol Pract. 2019;7(8):2812–2820.e3. doi:10.1016/j.jaip.2019.05.009
23.
WangHLiZYJiangWX, et al.The activation and function of IL-36γ in neutrophilic inflammation in chronic rhinosinusitis. J Allergy Clin Immunol. 2018;141(5):1646–1658. doi:10.1016/j.jaci.2017.12.972
24.
HarveyRJWallworkBDLundVJ. Anti-inflammatory effects of macrolides: applications in chronic rhinosinusitis. Immunol Allergy Clin North Am. 2009;29(4):689–703. doi:10.1016/j.iac.2009.07.006
25.
ShiLLXiongPZhangL, et al.Features of airway remodeling in different types of Chinese chronic rhinosinusitis are associated with inflammation patterns. Allergy. 2013;68(1):101–109. doi:10.1111/all.12064
26.
PothovenKLNortonJESuhLA, et al.Neutrophils are a major source of the epithelial barrier disrupting cytokine oncostatin M in patients with mucosal airways disease. J Allergy Clin Immunol. 2017;139(6):1966–1978.e9. doi:10.1016/j.jaci.2016.10.039
27.
SchleimerRP. Immunopathogenesis of chronic rhinosinusitis and nasal polyposis. Annu Rev Pathol. 2017;12:331–357. doi:10.1146/annurev-pathol-052016-100401
28.
LiaoBLiuJXLiZY, et al.Multidimensional endotypes of chronic rhinosinusitis and their association with treatment outcomes. Allergy. 2018;73(7):1459–1469. doi:10.1111/all.13411
29.
WenWLiuWZhangL, et al.Increased neutrophilia in nasal polyps reduces the response to oral corticosteroid therapy. J Allergy Clin Immunol. 2012;129(6):1522–1528.e5. doi:10.1016/j.jaci.2012.01.079
30.
TamaokiJ. The effects of macrolides on inflammatory cells. Chest. 2004;125(2 Suppl):41S–50S; quiz 1S. doi:10.1378/chest.125.2_suppl.41S
31.
BresciaGAlessandriniLZanottiC, et al.Histopathological and hematological changes in recurrent nasal polyposis. Int Forum Allergy Rhinol. 2019;9(7):813–820. doi:10.1002/alr.22314
32.
OrtizEAltemaniAVigoritoACSakanoENicolaEM. Rhinosinusitis in hematopoietic stem cell-transplanted patients: influence of nasosinus mucosal abnormalities?Stem Cell Res Ther. 2014;5(6):133. doi:10.1186/scrt523
33.
OrtizÉSakanoEMeirellesLR, et al.Histological features of the nasal mucosa in hematopoietic stem cell transplantation. Am J Rhinol Allergy. 2011;25(5):e191–e195. doi:10.2500/ajra.2011.25.3644
34.
GudisDZhaoKQCohenNA. Acquired cilia dysfunction in chronic rhinosinusitis. Am J Rhinol Allergy. 2012;26(1):1–6. doi:10.2500/ajra.2012.26.3716
35.
IkedaKOshimaTFurukawaM, et al.Restoration of the mucociliary clearance of the maxillary sinus after endoscopic sinus surgery. J Allergy Clin Immunol. 1997;99(1 Pt 1):48–52.
36.
CandeloEDarakjianAAvila-CastanoKDonaldsonA. Risk factors for recalcitrant chronic rhinosinusitis in non-solid and solid transplant recipients. Am J Rhinol Allergy. 2023;37(5):550–557. doi:10.1177/19458924231177855
37.
XuXSeetJEYapQV, et al.Latent class analysis of structured histopathology in prognosticating surgical outcomes of chronic rhinosinusitis with nasal polyps in Singapore. Rhinology. 2023;61(4):358–367.
