Sinonasal disorders in hematopoietic stem cell transplantation

Introduction Survival rates of solid organ transplant recipients are steadily increasing. Chronic immunosuppression is a key to sustain the transplanted organ. Thus, these patients are at a higher risk for fulminant disease and severe complications of rhinosinusitis (RS). Surprisingly, this has been scarcely discussed in the literature. Objective To analyze the characteristics and disease course of RS in solid organ transplant recipients. Materials and Methods Retrospective study. Medical records of all solid organ transplant recipients with a diagnosis RS treated at a national transplant center between the years 2001 and 2016 were reviewed. Results Of 4562 solid organ transplant recipients, a documented diagnosis of RS was identified only in 61 (1.3%) patients. Sixty-four patients presented with posttransplantation RS; of them, 54.5% had chronic RS (CRS) and the remaining 45.5% patients were diagnosed with acute RS. Microbial cultures grew almost exclusively bacterial pathogens. A documented invasive fungal infection was noted in only 2 patients. A total of 24 (40%) patients underwent endoscopic sinus surgery, the majority (22) for CRS. On subgroup analysis, surgical intervention was more frequent in lung transplant recipients ( P = .005). Neither specific disease nor surgical complications were found. Conclusions Interestingly, acute fulminant infection or sinusitis complications in solid organ transplant patients were much lower than expected. CRS in this patient group was less frequent than expected as well. Whether chronic immunosuppression minimizes the likelihood for CRS deserves further investigation. A more surgically oriented approach in CRS patients may be favored early in the management course of medically refractory patients in light of patients excellent outcomes.

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“…In contrast, the incidence of RS in bone marrow transplant patients has been reported to be up to 44%. 5,6,9,10…”

Section: Discussionmentioning

confidence: 99%

Rhinosinusitis in Solid Organ Transplant Recipients: Analysis of 4562 Transplanted Patients

Tzelnick

Soudry

2018

Am J Rhinol�Allergy

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“…In current literature there are numerous studies that value the incidence of sinonasal disorders in HSCT in general [29][30][31][32][33], but very few studies focused on rhinosinusitis in b-thalassemic patients [34,35] and only one analysed the impact of beta thalassemia on maxillary sinuses [36]. In this article Ragab et al, analysed data from 20 b-thalassemic children and 20 healthy controls.…”

Section: Discussionmentioning

confidence: 93%

Radiological and clinical difficulties in the management of chronic maxillary sinusitis in β Thalassemic paediatric patients

Mauro

Greco

Melis

et al. 2016

International Journal of Pediatric Otorhinolaryngology

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“…Hematologic transplant patients are commonly immunocompromised from their disease or treatment and are thus at high risk for infection. As sinusitis is relatively common in this population, understanding the impact of this disease in this high‐risk population may increase awareness and stimulate efforts to reduce costs …”

Section: Discussionmentioning

confidence: 99%

“…As sinusitis is relatively common in this population, understanding the impact of this disease in this high-risk population may increase awareness and stimulate efforts to reduce costs. 10,11 Sinusitis, which impacts approximately 15% of the general population, has been shown to have considerable economic impact in terms of direct healthcare costs, estimated to be $5.8 billion annually. 12 Prior studies have evaluated the economic impact of infections in transplant patients.…”

Section: Discussionmentioning

confidence: 99%

The Burden of Sinusitis in Hematologic Transplant Patients: A National Perspective

Pandrangi

Reiter

2018

The Laryngoscope

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Objectives/Hypothesis To determine the impact of sinusitis on outcomes of hematologic transplant procedures. Study Design Retrospective analysis of a national hospital database. Methods The National Inpatient Sample database for 2012 to 2013 was queried using International Classification of Diseases, Ninth Revision, Clinical Modification codes to identify patients undergoing hematologic transplants. Patients were divided based upon the presence or absence of a concomitant diagnosis of acute or chronic sinusitis. Patient demographics, clinical characteristics, discharge results, lengths of stay (LOS), and costs were compared between groups. Results There were 7,069 hematologic transplant cases identified, 2.7% of which had a diagnosis of sinusitis. Sinusitis patients had a longer LOS after transplant (24.9 ± 15.9 days vs. 19.1 ± 17.4 days, P < .001) and higher total hospital charges ($487,941 ± $447,532 vs. $322,300 ± $369,596, P < .001) than nonsinusitis patients. There was no difference in mortality between the two groups (P = .75). The 23 (12%) sinusitis patients who underwent sinus procedures had a longer LOS after transplant (34.8 ± 25 days vs. 23.5 ± 13.7 days, P = .001) and higher total hospital charges ($857,891 ± $718,456 vs. $437,293 ± $372,075, P < .001) than sinusitis patients without sinus procedures. Linear regression showed that sinusitis patients had excess LOS after transplant of 2.442 days and cost of $82,000.098. Conclusions This study demonstrates that presence of sinusitis in patients undergoing hematologic transplant is associated with increased LOS and higher total hospital charges. Increased focus on diagnosis and if possible treatment of sinusitis prior to admission for transplantation may help reduce the impact of sinusitis after hematologic transplant. Level of Evidence NA Laryngoscope, 128:2688–2692, 2018

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Sinonasal disorders in hematopoietic stem cell transplantation

Abstract: there was a higher frequency of rhinosinusitis in HSCT and GVHD. The type of transplant does not appear to predispose to the occurrence of rhinosinusitis. GVHD seems to be an aggravating factor and requires a more stringent treatment.

Cited by 15 publications

References 16 publications

Rhinosinusitis in Solid Organ Transplant Recipients: Analysis of 4562 Transplanted Patients

Rhinosinusitis in Solid Organ Transplant Recipients: Analysis of 4562 Transplanted Patients

Radiological and clinical difficulties in the management of chronic maxillary sinusitis in β Thalassemic paediatric patients

The Burden of Sinusitis in Hematologic Transplant Patients: A National Perspective

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