Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Jacksonville, Florida, USA.
Department of Social Science and Public Policy, Florida State University, Tallahassee, Florida, USA.
Otolaryngol Head Neck Surg. 2023 May;168(5):1217-1227. doi: 10.1002/ohn.236. Epub 2023 Jan 27.
Studies suggest that transplant patients are at risk for chronic rhinosinusitis (CRS). However, there is limited information in the literature regarding frequency and reasons for failure of adequate medical therapy. We aim to determine the risk factors associated with the development of medically recalcitrant CRS requiring endoscopic sinus surgery (ESS).
Retrospective cohort.
Mayo Clinic.
This is a retrospective chart review of 925 transplant recipients seen at Mayo Clinic between 2017 and 2022.
(1) a rhinologic consultation after transplant and (2) clinical diagnosis of CRS. A total of 549 patients met the inclusion criteria and were divided based on the need for ESS versus successful treatment with medical therapy. Univariate and logistic regression analyses were performed to identify risk factors and predictive variables related to failure of medical therapy.
Of the 549 patients, 201/549 (37%) had medically recalcitrant disease requiring ESS, while 348/549 (63%) were successfully treated with medical therapy Based on logistic regression, patients with recurrent acute rhinosinusitis in the pretransplant period were 8.68 more likely to have a recalcitrant disease (95% confidence interval, 3.72-20.28, p < 0.0001). Some of the largest determinants of medical therapy failure in the posttransplant period were CRS with nasal polyps, odontogenic CRS, and noninvasive fungal sinusitis. The presence of neutropenia, aplastic anemia, and living transplant were also associated with medically recalcitrant CRS requiring ESS.
Our predictive model identifies with high accuracy the patients who may be at risk of developing recalcitrant CRS in the organ transplant population.
研究表明，移植患者存在慢性鼻-鼻窦炎（CRS）风险。然而，文献中关于充分药物治疗失败的频率和原因的信息有限。我们旨在确定与需要内镜鼻窦手术（ESS）的药物难治性 CRS 发展相关的风险因素。
回顾性队列研究。
梅奥诊所。
这是一项对 2017 年至 2022 年期间在梅奥诊所就诊的 925 名移植受者进行的回顾性图表审查。
（1）移植后进行鼻科会诊；（2）临床诊断为 CRS。共有 549 名患者符合纳入标准，并根据是否需要 ESS 或成功接受药物治疗进行分组。进行单变量和逻辑回归分析，以确定与药物治疗失败相关的风险因素和预测变量。
在 549 名患者中，201/549（37%）患有需要 ESS 的药物难治性疾病，而 348/549（63%）通过药物治疗成功治疗。基于逻辑回归，移植前有复发性急性鼻-鼻窦炎的患者发生难治性疾病的可能性增加 8.68 倍（95%置信区间，3.72-20.28，p<0.0001）。移植后药物治疗失败的最大决定因素包括 CRS 伴鼻息肉、牙源性 CRS 和非侵袭性真菌性鼻窦炎。中性粒细胞减少症、再生障碍性贫血和活体移植的存在也与需要 ESS 的药物难治性 CRS 相关。
我们的预测模型可以准确识别出可能在器官移植人群中发生难治性 CRS 的患者。
