Rhinosinusitis in autologous and allogeneic bone marrow transplantation: a retrospective study on the performance of imaging studies on severity and prognostic evaluation

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%

“…In contrast, the incidence of RS in bone marrow transplant patients has been reported to be up to 44%. 5,6,9,10 Dhong et al 11 analyzed 278 transplant recipient patients; 12% (n ¼ 34) were bone marrow transplant recipients and the remainder were liver, kidney, and heart transplant recipients. No lung transplant recipients were included.…”

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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“…Therefore, the evaluation of sinusitis in this particular post-HSCT population is important. To date, despite the widespread use of screening CT, there are very few studies in the literature assessing the utility of this modality in children undergoing HSCT, 3, 7 and there is no clear consensus.…”

Section: Discussionmentioning

confidence: 99%

“…5, 6 Reliable identification of sinusitis is further complicated in the setting of immunosuppression, where radiographic abnormalities may appear relatively nonspecific without significant mucosal thickening or air-fluid levels. 7 Therefore, comparison with pre-HSCT to assess for baseline changes may be important in the workup for children with neutropenic fever. In addition, in current practice, acute sinusitis is typically a clinical diagnosis, and unlike chronic sinusitis, it is rarely imaged.…”

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confidence: 99%

The Role of Screening Sinus Computed Tomography in Pediatric Hematopoietic Stem Cell Transplant Patients

Zamora¹,

Oppenheimer²,

Dave³

et al. 2015

Journal of Computer Assisted Tomography

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Objective The objective of this study was to evaluate pretransplant sinus computed tomography (CT) as predictor of post–hematopoietic stem cell transplant sinusitis. Methods We evaluated pretransplant and posttransplant CT findings in 100 children using the Lund-Mackay system and “common-practice” radiology reporting and correlated these with the presence of acute sinusitis. Results Fourteen percent of patients with normal screening CT developed posttransplant sinusitis, compared with 23%with radiographic abnormalities and 22% with clinical sinusitis alone, not statistically significant. Sensitivity of CT findings for clinical sinusitis ranged between 19% and 56%. Except for mucosal thickening (71% specificity), other findings had high specificity between 92% and 97%, particularly when combined. Lund-Mackay score change of 10 or greater from baseline was associated with a 2.8-fold increased likelihood of having sinusitis (P < 0.001). Conclusions Screening CT can serve as a baseline, with a Lund-Mackay score change of 10 or greater constituting a significant threshold. The strongest correlation with the presence of acute sinusitis was seen with combined CT findings.

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“…26 Prevalence of CRS may be higher in patients posttransplantation (5% to 44%). [27][28][29][30][31] Immunosuppressive drug therapy Variable depending on the type of immunosuppressive therapy. Most affect cell-mediated immunity.…”

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confidence: 99%

Medical and surgical treatment outcomes in patients with chronic rhinosinusitis and immunodeficiency: a systematic review

Samargandy

Grose

Chan

et al. 2020

Int Forum Allergy Rhinol

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Background Immunodeficiency is a risk factor for recalcitrant chronic rhinosinusitis CRS Currently there is no consensus on effective treatment modalities for immunodeficient CRS patients This review aims to evaluate the existing evidence on the treatment outcomes and its limitations in patients with CRS and immunodeficiency Methods MEDLINE Embase and the Cochrane Central Register of Controlled Trials CENTRAL were searched from inception to April for studies reporting measurable medical or surgical treatment outcomes for adult patients with CRS and underlying primary or secondary immunodeficiency Results Of the articles screened studies met the inclusion criteria prospective double-blind placebocontrolled trials prospective case-control studies prospective cohort studies and case series The high degree of study heterogeneity precluded a meta-analysis Antibiotic monotherapy was not linked with significant improvement in clinical radiographic or endoscopic outcomes Immunoglobulin replacement therapy may potentially reduce the frequency of acute or chronic sinusitis in patients with primary immunodeficiency PID but may not improve their sinonasal symptoms Outcomes from endoscopic sinus surgery ESS were reported in studies which found that surgery was linked with improvement in symptoms disease-specific quality of life endoscopy scores and radiographic scores The average reported ESS revision rate was Conclusion Patients with CRS and immunodeficiency likely benefit from ESS based on the available evidence Data supporting medical therapy in this targeted population is limited overall but there may be a potential role for immunoglobulin therapy in patients with PID and CRS © 2020 ARS-AAOA, LLC.

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Rhinosinusitis in autologous and allogeneic bone marrow transplantation: a retrospective study on the performance of imaging studies on severity and prognostic evaluation

Cited by 7 publications

References 7 publications

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

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

The Role of Screening Sinus Computed Tomography in Pediatric Hematopoietic Stem Cell Transplant Patients

Medical and surgical treatment outcomes in patients with chronic rhinosinusitis and immunodeficiency: a systematic review

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