The burden of sinus disease in cystic fibrosis lung transplant recipients

Morlacchi, Letizia Corinna; Greer, Mark; Tudorache, I.; Blasi, Francesco; Welte, Tobias; Haverich, Axel; Mainz, Jochen G.; Gottlieb, Jens

doi:10.1111/tid.12924

Cited by 26 publications

(10 citation statements)

References 59 publications

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“…However, approximately 40% of lung transplant recipients in two studies reported intolerance to or lack of benefit with ELX/TEZ/IVA 20,22 . Sinus disease was noted as the most frequent indication for patients prescribed ELX/TEZ/IVA in the studies published by Ramos et al and Doligalski et al This finding aligns with the reported burden of sinus symptoms in approximately 60% of lung transplant recipients 22,25 . Improvement of sinus symptoms reported in the cases published by Benninger and Hayes provides yet another possible niche for modulator therapy in the lung transplant population 14,15 …”

Section: Discussionsupporting

confidence: 62%

Use of CFTR modulators in special populations, part 3: Solid organ transplant

Kadouh

Elijah

Fitzgerald

et al. 2023

Pediatric Pulmonology

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BackgroundSolid organ transplant (SOT) recipients with cystic fibrosis (CF) may benefit from the pulmonary and extrapulmonary benefits associated with CF transmembrane conductance regulator modulators. Nevertheless, evolution of modulator safety and efficacy data prompts consideration.MethodsThe search terms “transplant” AND “ivacaftor"(IVA) OR "lumacaftor"(LUM) OR "tezacaftor" (TEZ) OR "elexacaftor" (ELX) were utilized to conduct a scoping review of English articles from the period of January 1, 2012 to December 31, 2022. Search results from PubMed and Embase databases were reviewed by title and abstract for relevance. Included studies reported efficacy and safety outcomes of modulators in SOT recipients.ResultsOne hundred thirty‐six patients from one cohort study (90 lung transplant recipients) and eight case reports and series (29 lung transplant recipients, 16 liver transplant recipients and one lung/liver transplant patient) were included. Post‐modulator initiation, 33 patients did not necessitate tacrolimus dose adjustments, 10 required dose uptitration, and 43 required dose reductions. Moreover, LUM/IVA use with azole antifungals may lead to subtherapeutic levels but opposing effects sustained tacrolimus levels. Liver transplant recipients were more likely to experience elevations in transaminases requiring pharmacologic or medical interventions. Majority of patients experienced improvements in pulmonary function, fasting blood glucose, hemoglobin, body mass index, and rhinosinusitis symptoms. However, intolerance or lack of benefit prompted discontinuation of ELX/TEZ/IVA in over 40% of lung‐transplant recipients in one study.ConclusionModulator therapy has been reported to produce pulmonary and extra‐pulmonary benefits in the CF population with SOT. Considerations for modulator therapy initiation ought to include modulator pharmacokinetics, concomitant medications, and transplant type due to the complex nature of SOT recipients.

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Section: Discussionsupporting

confidence: 62%

Use of CFTR modulators in special populations, part 3: Solid organ transplant

Kadouh

Elijah

Fitzgerald

et al. 2023

Pediatric Pulmonology

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“…The nasal/paranasal sinuses have been proven to be a reservoir both in people with CF and primary ciliary dyskinesia. M orlacchi et al [ 20 ] demonstrated that a large number of patients had the same pathogens colonising both LAW and UAW after lung transplant. In addition, a number of studies have shown that P. aeruginosa and S. aureus clones can be found both in the LAW and UAW of these patients [ 12 , 21 ].…”

Section: Discussionmentioning

confidence: 99%

Longitudinal monitoring of sinonasal and oral bacterial reservoirs to prevent chronic lung infection in people with cystic fibrosis

et al. 2020

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BackgroundParanasal sinuses act as bacterial reservoirs and contribute to transmitting bacteria to the lower airway of patients with cystic fibrosis (CF). Also, passage of bacteria from the oral cavity to the lungs may occur.MethodsWe evaluated the presence of Pseudomonas aeruginosa, Staphylococcus aureus, Stenotrophomonas maltophilia, Achromobacter xylosoxidans and Serratia marcescens in sputum and nasal lavage of 59 patients with CF, and also collected saliva and used toothbrushes from 38 of them. We assessed the clonal identity of the strains isolated from the different samples by pulsed-field gel electrophoresis.ResultsAbout 80% of the patients were positive for at least one of the bacterial species examined in nasal lavage and sputum. Among the subjects with positive sputum, 74% presented the same species in the nasal lavage and saliva, and 26% on their toothbrush. S. aureus was the most abundant species in all samples. Clonal identity (≥80% similarity) of the strains isolated among the different samples from each patient was confirmed in almost all cases. Longitudinal observation helped to identify five patients who were colonised in the lower airways after an initial period of nasal or oral colonisation.ConclusionNasal and oral sites act as bacterial reservoirs, favouring the transmission of potentially pathogenic microorganisms to the lower airway. The lack of eradication from these sites might undermine the antibiotic therapy applied to treat the lung infection, allowing the persistence of the bacteria within the patient if colonisation of these sites is not assessed, and no specific therapy is performed.

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“…These organisms may recolonize after transplantation and increase the risk of graft dysfunction. Although the evidence is insufficient, sinus surgery before transplantation can be considered, and even if surgery is not performed, accurate evaluation and treatment are required before and after transplantation [ 56 ].…”

Section: Disease-specific Guidelinesmentioning

confidence: 99%

Indications for Lung Transplantation and Patient Selection

Son

Shin

2022

J Chest Surg

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Globally, thousands of patients undergo lung transplantation owing to end-stage lung disease each year. As lung transplantation evolves, recommendations and indications are constantly being updated. In 2021, the International Society for Heart and Lung Transplantation published a new consensus document for selecting candidates for lung transplantation. However, it is still difficult to determine appropriate candidates for lung transplantation among patients with complex medical conditions and various diseases. Therefore, it is necessary to analyze each patient’s overall situation and medical condition from various perspectives, and ongoing efforts to optimize the analysis will be necessary. The purpose of this study is to review the extant literature and discuss recent updates.

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The burden of sinus disease in cystic fibrosis lung transplant recipients

Cited by 26 publications

References 59 publications

Use of CFTR modulators in special populations, part 3: Solid organ transplant

Use of CFTR modulators in special populations, part 3: Solid organ transplant

Longitudinal monitoring of sinonasal and oral bacterial reservoirs to prevent chronic lung infection in people with cystic fibrosis

Indications for Lung Transplantation and Patient Selection

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