Clinical course of rhinosinusitis and efficacy of sinonasal evaluation in kidney transplant recipients: review of 1589 patients

Abstract

The prevalence and recurrence rate of rhinosinusitis in KT patients was not increased after KT. Symptomatic patients needed surgical or medical treatment before KT, but asymptomatic patients showed no deterioration of clinical course after KT. Routine sinonasal evaluation for asymptomatic patients is not recommended before KT.

Outcomes of head and neck surgery in patients with a history of solid organ transplantation

“…The results led them to conclude that routine sinonasal evaluation for asymptomatic patients is not recommended before kidney transplantation. 25 Our study demonstrated an upward trend in organ recipients who require otolaryngologic care, and this trend is likely to continue beyond the study period. However, this needs to be verified when the data of forecasted years become available.…”

“…In a study by Ryu et al that evaluated rhinosinusitis course and manifestation in 1,589 patients before and after undergoing kidney transplantation in South Korea, it was reported that the prevalence of rhinosinusitis did not increase after transplantation. The prevalence before transplantation (4.2%) was significantly higher than posttransplantation prevalence (0.9%) . Furthermore, Ryu et al reported the recurrence rate of rhinosinusitis was not significantly different comparing the pretransplantation group to the posttransplantation group.…”

“…Major and nonmajor sinonasal procedures were performed in 15.2% of the study population mostly for nonmalignant conditions. As a result of immunosuppression, solid organ recipients are at risk of a wide array of nasal and paranasal sinuses manifestations such as acute and chronic rhinosinusitis, fungal ball, and acute invasive fungal rhinosinusitis . In a study by Ryu et al that evaluated rhinosinusitis course and manifestation in 1,589 patients before and after undergoing kidney transplantation in South Korea, it was reported that the prevalence of rhinosinusitis did not increase after transplantation.…”

“…Furthermore, Ryu et al reported the recurrence rate of rhinosinusitis was not significantly different comparing the pretransplantation group to the posttransplantation group. The results led them to conclude that routine sinonasal evaluation for asymptomatic patients is not recommended before kidney transplantation …”

Otorhinolaryngological dysfunctions induced by chronic kidney disease in pre- and post-transplant stages

“…Poor nutritional status Sinonasal/rhino-cerebral mucormycosis mainly presents as headache, facial swelling and pain (especially over affected areas), nasal discharge, and necrotic lesions on the face, nasal cavities, or palates [4,45] Rhino-cerebral form is most common form of mucormycosis in RTRs [4] Maxillary and ethmoid sinuses are mainly affected [45] Olfactory loss/ dysfunction 56% of patients with ESKD are affected [48] Exact mechanism is unknown It might result from uremia-induced negative effect on peripheral nerve conduction and central cognitive functions [47] Might be reversible-improvement of proper olfaction observed after renal transplantation and after dialysis session [47] Olfactory identification and discrimination are mainly affected; thresholds seem to remain unchanged [47] CT of paranasal sinuses before organ transplant not recommended in asymptomatic individuals because of the high rate of false positive results [44] Relatively low incidence of rhinosinusitis in RTRs might result from persistent low-dose prednisone therapy withholding the inflammatory responses that frequently promote CRS [44] Voice dysfunction Hoarseness 24-60% of patients with ESKD are affected [50] Potential mechanism [15] Excessive fluid and toxins accumulation, and acidbase imbalance Vocal cord edema Decreased pulmonary function Abnormal coordination between central nervous system and peripheral phonatory structures Laryngeal muscles fatigue Patients with ESKD on HD might suffer from temporary post-dialysis hoarseness as a result of HD-induced dehydration, reduction of the vocal cord size and increase in subglottic pressure [50] Bony changes…”