Assessing the Impact of Recurrent Acute Rhinosinusitis Development in Posttransplant Patients: A Study on Sinus Surgery Necessity

Introduction: Recurrent acute rhinosinusitis (RARS) significantly decreases quality of life. Transplant recipients (TR) are particularly vulnerable to rhinologic conditions. There is a notable lack of guidelines for managing RARS in this population. Our study aims to determine the prevalence of and risk factors for RARS among transplant recipients and assess the need for sinus surgery within this group.

Methods: This is a retrospective cohort of 2,146 TR seen at Mayo Clinic between 2017 and 2022. A total of 1,115 patients met inclusion criteria and were divided based on the presence or absence of a new incident RARS diagnosis during the post-transplant period and frequency of sinus surgery. Logistic regression analysis was performed to identify odds ratio.

Results: 111/1,115 (9.95%) had RARS. Patients with RARS had increased history of asthma, viral infection, and rheumatoid arthritis (RA) (p=0.003) in the pre-transplant period. According to the logistic regression analysis, patients with neutropenia, RA, and mantle cell lymphoma were 1.85, 3.10, and 3.54 times more likely to develop RARS (95% CI 1.16 – 2.92, p=0.01), (95% CI 1.06 -9.04, p=0.03), (95% CI 1.02 -12.26, p=0.05) during the post-transplant period, respectively. In those that developed RARS, only 4.8% failed medical therapy and required surgery. The logistic regression model for RARS correctly identifies 89.63% of cases with a specificity 99.79%

Conclusions: This study represents the first cohort to investigate the incidence of RARS in transplant recipients and to identify predictive factors associated with its development post-transplant. We found that patients with pre-transplant comorbidities such as rheumatoid arthritis, viral infections, hematologic deficiencies, and malignancies were at an increased risk for developing RARS, though this is not linked to an increased necessity for sinus surgery.