Effects of Sinus Surgery on lung Transplantation Outcomes in Cystic Fibrosis

Abstract

Despite pretransplant sinus surgery, recolonization of lung grafts occurs commonly and rapidly with a spectrum of flora that mimics the sinus flora. Survival rates of CF patients who undergo prophylactic sinus surgery are similar to those from centers where prophylactic sinus surgery is not performed routinely. Pretransplant sinus surgery does not appear to prevent lung graft recolonization and is not associated with overall survival benefit.

Impact of Sinus Surgery on Pseudomonal Airway Colonization, Bronchiolitis Obliterans Syndrome and Survival in Cystic Fibrosis Lung Transplant Recipients

“…This finding is consistent to those of other groups [3,19,20,21]. Leung et al [17], who followed a protocol of pre-transplant sinus surgery, observed no significant benefit to long-term survival relative to other comparable cohorts of CF patients with no sinus surgery. However, their protocol did not include daily nasal care, which is essential to achieving the persistent eradication of pathologic bacteria in the sinuses.…”

“…In a larger study, including 87 patients with pre-transplant sinus surgery, 82 and 87% had persistent PNC and PPC, respectively [17]. In our previous study, PNC persisted in 46% [5].…”

“…Special attention should be attributed to the eradication of bacteria in the sinuses, which requires endoscopic sinus surgery and daily nasal douching with isotonic saline solution. The authors who did not include daily nasal care in their protocol observed no significant reduction in bacteria type or bacterial recolonization [17,18]. …”

“…There are only a few studies that examine the success rate of Pseudomonas eradication in post-transplant recipients [3,5,17,19]. In a larger study, including 87 patients with pre-transplant sinus surgery, 82 and 87% had persistent PNC and PPC, respectively [17].…”

Bacteriology of the paranasal sinuses in pediatric cystic fibrosis patients

“…Sinus disease contributes significant morbidity to CF due to the connection between sinus disease and disease in the distal airway in pediatric CF patients [2,[5][6][7][8]. Better understanding of sinus bacteriology in pediatric CF patients may assist in targeted treatment of distal airway infections in the future.…”