Impact of extended sinus surgery on allograft infection, allograft function and overall survival in cystic fibrosis lung transplant recipients.
Chronic allograft dysfunction
Cystic fibrosis
Extended sinus surgery
Infectious events
Lung transplantation
Journal
European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery
ISSN: 1434-4726
Titre abrégé: Eur Arch Otorhinolaryngol
Pays: Germany
ID NLM: 9002937
Informations de publication
Date de publication:
Oct 2023
Oct 2023
Historique:
received:
08
03
2023
accepted:
15
05
2023
medline:
5
9
2023
pubmed:
30
5
2023
entrez:
30
5
2023
Statut:
ppublish
Résumé
Studies investigating the impact of sinus surgery for cystic fibrosis (CF) patients performed early after lung transplantation (Ltx) are scarce. Recent studies evaluating frequency of respiratory infections and graft outcomes are not available. To determine whether there is a difference in allograft infection, allograft function and overall survival among CF lung transplant recipients with and without concomitant sinus surgery. Retrospective single-center study. We examined 71 CF patients who underwent Ltx between 2009 and 2019 at our center. Fifty-nine patients had sinus surgery before or/and after transplantation and twelve did not undergo sinus surgery. We assessed the survival, the diagnosis of chronic allograft dysfunction (CLAD) and all elevated (> 5 mg/l) c-reactive protein episodes during the observed period. The infectious events of the upper and lower airways were categorized in mild infections (5-15 mg/l CRP) and severe infections (> 15 mg/l CRP). There was no difference in the long-time overall survival (p = 0.87) and no benefit in the short-term survival at 4 year post-transplant (p = 0.29) in both groups. There was no difference in both groups concerning CLAD diagnosis (p = 0.92). The incidence of severe upper and lower airway infections (CRP > 15 mg/l) was significantly decreased in the sinus surgery group (p = 0.015), whereas in mild infections there was a trend to decreased infections in the sinus surgery group (p = 0.056). CF patients undergoing Ltx benefit from extended endoscopic sinus surgery (eESS) in terms of frequency of severe infectious events of the upper and lower airways. There was no difference in overall survival and frequency of CLAD in the two groups.
Sections du résumé
BACKGROUND
BACKGROUND
Studies investigating the impact of sinus surgery for cystic fibrosis (CF) patients performed early after lung transplantation (Ltx) are scarce. Recent studies evaluating frequency of respiratory infections and graft outcomes are not available.
OBJECTIVES/HYPOTHESIS
OBJECTIVE
To determine whether there is a difference in allograft infection, allograft function and overall survival among CF lung transplant recipients with and without concomitant sinus surgery.
STUDY DESIGN
METHODS
Retrospective single-center study.
METHODS
METHODS
We examined 71 CF patients who underwent Ltx between 2009 and 2019 at our center. Fifty-nine patients had sinus surgery before or/and after transplantation and twelve did not undergo sinus surgery. We assessed the survival, the diagnosis of chronic allograft dysfunction (CLAD) and all elevated (> 5 mg/l) c-reactive protein episodes during the observed period. The infectious events of the upper and lower airways were categorized in mild infections (5-15 mg/l CRP) and severe infections (> 15 mg/l CRP).
RESULTS
RESULTS
There was no difference in the long-time overall survival (p = 0.87) and no benefit in the short-term survival at 4 year post-transplant (p = 0.29) in both groups. There was no difference in both groups concerning CLAD diagnosis (p = 0.92). The incidence of severe upper and lower airway infections (CRP > 15 mg/l) was significantly decreased in the sinus surgery group (p = 0.015), whereas in mild infections there was a trend to decreased infections in the sinus surgery group (p = 0.056).
CONCLUSIONS
CONCLUSIONS
CF patients undergoing Ltx benefit from extended endoscopic sinus surgery (eESS) in terms of frequency of severe infectious events of the upper and lower airways. There was no difference in overall survival and frequency of CLAD in the two groups.
Identifiants
pubmed: 37249595
doi: 10.1007/s00405-023-08028-3
pii: 10.1007/s00405-023-08028-3
pmc: PMC10477110
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
4501-4507Informations de copyright
© 2023. The Author(s).
Références
O’Sullivan BP, Freedman SD (2009) Cystic fibrosis. Lancet 373(9678):1891–1904. https://doi.org/10.1016/S0140-6736(09)60327-5
doi: 10.1016/S0140-6736(09)60327-5
pubmed: 19403164
Ratjen F, Döring G (2003) Cystic fibrosis. Lancet 361(9358):681–689. https://doi.org/10.1016/S0140-6736(03)12567-6
doi: 10.1016/S0140-6736(03)12567-6
pubmed: 12606185
Hofer M, Benden C, Inci I et al (2009) True survival benefit of lung transplantation for cystic fibrosis patients: the Zurich experience. J Heart Lung Transplant 28(4):334–339. https://doi.org/10.1016/j.healun.2008.12.025
doi: 10.1016/j.healun.2008.12.025
pubmed: 19332259
Vital D, Hofer M, Boehler A, Holzmann D (2013) Posttransplant sinus surgery in lung transplant recipients with cystic fibrosis: a single institutional experience. Eur Arch Otorhinolaryngol 270(1):135–139. https://doi.org/10.1007/s00405-012-2002-y
doi: 10.1007/s00405-012-2002-y
pubmed: 22460525
Johnson JR, Hwang PH, Nayak JV, Patel ZM (2022) Comparison of endoscopic sinus surgery timing in lung transplant patients with cystic fibrosis. Int Forum Allergy Rhinol 12(6):821–827. https://doi.org/10.1002/alr.22935
doi: 10.1002/alr.22935
pubmed: 34875144
Eggesbø HB, Søvik S, Dølvik S, Eiklid K, Kolmannskog F (2003) Proposal of a CT scoring system of the paranasal sinuses in diagnosing cystic fibrosis. Eur Radiol 13(6):1451–1460. https://doi.org/10.1007/s00330-003-1825-8
doi: 10.1007/s00330-003-1825-8
pubmed: 12682781
Figiel W, Grąt M, Niewiński G, Patkowski W, Zieniewicz K (2020) Applicability of common inflammatory markers in diagnosing infections in early period after liver transplantation in intensive care setting. Sci Rep 10(1):3918. https://doi.org/10.1038/s41598-020-60936-0
doi: 10.1038/s41598-020-60936-0
pubmed: 32127631
pmcid: 7054413
Leung M-K, Rachakonda L, Weill D, Hwang PH (2008) Effects of sinus surgery on lung transplantation outcomes in cystic fibrosis. Am J Rhinol 22(2):192–196. https://doi.org/10.2500/ajr.2008.22.3146
doi: 10.2500/ajr.2008.22.3146
pubmed: 18416979
Holzmann D, Speich R, Kaufmann T et al (2004) Effects of sinus surgery in patients with cystic fibrosis after lung transplantation: a 10-year experience. Transplantation 77(1):134–136. https://doi.org/10.1097/01.TP.0000100467.74330.49
doi: 10.1097/01.TP.0000100467.74330.49
pubmed: 14724449
Vital D, Hofer M, Benden C, Holzmann D, Boehler A (2013) Impact of sinus surgery on pseudomonal airway colonization, bronchiolitis obliterans syndrome and survival in cystic fibrosis lung transplant recipients. Respiration 86(1):25–31. https://doi.org/10.1159/000339627
doi: 10.1159/000339627
pubmed: 22922656
Maurer J (2009) Pseudomonas aeruginosa colonization of the allograft after lung transplantation and the risk of Bronchiolitis Obliterans syndrome. Yearbook Pulmonary Dis 2009:255–256. https://doi.org/10.1016/S8756-3452(08)79140-0
doi: 10.1016/S8756-3452(08)79140-0
Chaaban MR, Kejner A, Rowe SM, Woodworth BA (2013) Cystic fibrosis chronic rhinosinusitis: a comprehensive review. Am J Rhinol Allergy 27(5):387–395. https://doi.org/10.2500/ajra.2013.27.3919
doi: 10.2500/ajra.2013.27.3919
pubmed: 24119602
pmcid: 3899543
Taylor CJ, McGaw J, Howden R, Duerden BI, Baxter PS. Bacterial reservoirs in cystic fibrosis. Arch Dis Child. 1990;65(2):175-177. https://doi.org/10.1136/adc.65.2.175
Taylor RF, Morgan DW, Nicholson PS, Mackay IS, Hodson ME, Pitt TL (1992) Extrapulmonary sites of Pseudomonas aeruginosa in adults with cystic fibrosis. Thorax 47(6):426–428. https://doi.org/10.1136/thx.47.6.426
doi: 10.1136/thx.47.6.426
pubmed: 1496501
pmcid: 463806
Mainz JG, Naehrlich L, Schien M et al (2009) Concordant genotype of upper and lower airways P. aeruginosa and S. aureus isolates in cystic fibrosis. Thorax 64(6):535–540. https://doi.org/10.1136/thx.2008.104711
doi: 10.1136/thx.2008.104711
pubmed: 19282318
Mainz JG, Hentschel J, Schien C et al (2012) Sinonasal persistence of Pseudomonas aeruginosa after lung transplantation. J Cyst Fibros 11(2):158–161. https://doi.org/10.1016/j.jcf.2011.10.009
doi: 10.1016/j.jcf.2011.10.009
pubmed: 22133899
Morlacchi LC, Greer M, Tudorache I et al (2018) The burden of sinus disease in cystic fibrosis lung transplant recipients. Transpl Infect Dis 20(5):e12924. https://doi.org/10.1111/tid.12924
doi: 10.1111/tid.12924
pubmed: 29797646
Choi KJ, Cheng TZ, Honeybrook AL et al (2018) Correlation between sinus and lung cultures in lung transplant patients with cystic fibrosis. Int Forum Allergy Rhinol 8(3):389–393. https://doi.org/10.1002/alr.22067
doi: 10.1002/alr.22067
pubmed: 29240302
Pletcher SD, Goldberg AN, Cope EK (2019) Loss of microbial niche specificity between the upper and lower airways in patients with cystic fibrosis. Laryngoscope 129(3):544–550. https://doi.org/10.1002/lary.27454
doi: 10.1002/lary.27454
pubmed: 30284279
Shatz A (2006) Management of recurrent sinus disease in children with cystic fibrosis: a combined approach. Otolaryngol Head Neck Surg 135(2):248–252. https://doi.org/10.1016/j.otohns.2006.01.027
doi: 10.1016/j.otohns.2006.01.027
pubmed: 16890077
Virgin FW, Rowe SM, Wade MB et al (2012) Extensive surgical and comprehensive postoperative medical management for cystic fibrosis chronic rhinosinusitis. Am J Rhinol Allergy 26(1):70–75. https://doi.org/10.2500/ajra.2012.26.3705
doi: 10.2500/ajra.2012.26.3705
pubmed: 22391086
pmcid: 3622282
Luparello P, Lazio MS, Voltolini L, Borchi B, Taccetti G, Maggiore G (2019) Outcomes of endoscopic sinus surgery in adult lung transplant patients with cystic fibrosis. Eur Arch Otorhinolaryngol 276(5):1341–1347. https://doi.org/10.1007/s00405-019-05308-9
doi: 10.1007/s00405-019-05308-9
pubmed: 30689038
Tracy Z. Cheng, MHS, Kevin J. Choi, et al. Decreased antibiotic utilization after sinus surgery in cystic fibrosis patients with lung transplantation. Am J Rhinol Allergy. 2019;33(4):354-358. https://doi.org/10.1177/1945892419830624
Uyttebroek S, Dupont L, Jorissen M, van Gerven L (2023) Upper airway disease in adults with cystic fibrosis in the era of CFTR modulators. Laryngoscope. https://doi.org/10.1002/lary.30642
doi: 10.1002/lary.30642
pubmed: 36912358