Risk Factors for Recalcitrant Chronic Rhinosinusitis in Organ Transplant Recipients

Candelo, Estephanía; Avila‐Castano, Karol; Verez, Abigail; Abello‐Vaamonde, Jorge A.; Donaldson, Angela M.

doi:10.1002/ohn.236

Cited by 3 publications

(2 citation statements)

References 21 publications

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“…According to previous studies, immunosuppression is believed to be the most important factor in the development of CRS in this population. 3,7,12,17,24 However, several studies on this topic have focused on BMT rather than solid organ transplant recipients. 10,25 In our study, rejection and immunosuppressant therapy may have played a key role in the development of medically refractory CRS and the need for ESS in solid transplant recipients.…”

Section: Discussionmentioning

confidence: 99%

“…To our knowledge, few studies have delineated the incidence and potential risk factors for transplants of all types. 12 Additionally, the data that is available for different transplant types are quite variable and often do not describe the incidence of recalcitrant CRS that has failed medical therapy and required surgery. The primary aim of this study is to identify the incidence of recalcitrant CRS requiring ESS in non-solid and solid post-transplant recipients.…”

Section: Introductionmentioning

confidence: 99%

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Risk Factors for Recalcitrant Chronic Rhinosinusitis in Non-Solid and Solid Transplant Recipients

Candelo

Darakjian

Avila-Castano

et al. 2023

Am J Rhinol�Allergy

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Objectives Transplant patients are high risk for surgery due to their immunocompromised state. There is a paucity of evidence concerning the differences in incidence of chronic rhinosinusitis (CRS) in solid versus non-solid organ transplant. Our aim is to analyze the difference in incidence of CRS requiring endoscopic sinus surgery (ESS) between non-solid and solid transplant populations and determine if certain risk factors are associated with increased incidence of recalcitrant CRS in non-solid versus solid transplants. Study Design Retrospective cohort. Setting Multisite tertiary academic center. Methods This is a retrospective chart review of 1303 transplant recipients who were seen in our rhinologic clinic for CRS between 2017 and 2022. A total of 224 patients underwent ESS and were further analyzed for risk factors associated with recalcitrant disease requiring sinus surgery. Subgroup analysis based on solid and non-solid organ transplant was performed. Results Of the 224 patients in the study, 171/224 (76.3%) had solid transplants while 53/224 (23.6%) had non-solid transplants. 17.19% of all transplant recipients required ESS. The incidence of ESS in non-solid transplants was 28.2% versus 57% in solid transplant. The risk of recalcitrant CRS in solid transplant recipients was almost 1.78 times greater than those with non-solid organ transplant (95% CI, 1.27-2.54, p = 0.0005). Individual factors such as certain immunotherapy drugs, pancytopenia, and rejection appear to correlate with the risk of ESS in both non-solid and solid organ transplant. Conclusion Risk of ESS was greater in the solid transplant recipients compared to those who received non-solid organ transplant.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Risk Factors for Recalcitrant Chronic Rhinosinusitis in Non-Solid and Solid Transplant Recipients

Candelo

Darakjian

Avila-Castano

et al. 2023

Am J Rhinol�Allergy

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The impact of cadaveric donor transplant on the development of chronic rhinosinusitis and recalcitrant disease

Candelo,

Bohorquez‐Caballero,

Avila‐Castano

et al. 2024

Int Forum Allergy Rhinol

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Key points The study found a higher incidence of chronic rhinosinusitis (CRS) and recalcitrant CRS in cadaveric organ transplant recipients compared to those receiving living donor transplants. Recipients of cadaveric transplants were 1.32 times more likely to develop CRS and 1.68 times more likely to develop medically recalcitrant CRS. Living kidney transplants significantly reduced the risk of developing CRS (OR = 0.12) and recalcitrant CRS (OR = 0.11), highlighting a potentially protective effect against these conditions. In contrast, cadaveric liver transplants were associated with an increased risk of CRS and medically recalcitrant CRS. Kaplan–Meier survival analysis indicated a significant difference in time to CRS onset between cadaveric and living donor transplants. Median time to CRS onset was longer for living donor recipients (21.1 months) compared to cadaveric recipients (15.6 months). This study underscores the need for transplant teams and otolaryngologist to consider donor type during transplant follow‐up due to differing risks of CRS development.

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Predictors for Development of Chronic Rhinosinusitis in Transplant Recipients

Candelo,

Bohorquez-Caballero,

Avila-Castano

et al. 2024

Am J Rhinol�Allergy

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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.

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Risk Factors for Recalcitrant Chronic Rhinosinusitis in Organ Transplant Recipients

Cited by 3 publications

References 21 publications

Risk Factors for Recalcitrant Chronic Rhinosinusitis in Non-Solid and Solid Transplant Recipients

Risk Factors for Recalcitrant Chronic Rhinosinusitis in Non-Solid and Solid Transplant Recipients

The impact of cadaveric donor transplant on the development of chronic rhinosinusitis and recalcitrant disease

Predictors for Development of Chronic Rhinosinusitis in Transplant Recipients

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