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移植受者慢性鼻-鼻窦炎发展的预测因素。

Predictors for Development of Chronic Rhinosinusitis in Transplant Recipients.

机构信息

Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Jacksonville, Florida.

Department of Transplant, Mayo Clinic, Jacksonville, Florida.

出版信息

Am J Rhinol Allergy. 2024 Nov;38(6):373-383. doi: 10.1177/19458924241272990. Epub 2024 Aug 25.

Abstract

OBJECTIVES

Studies suggest that transplant patients are at a higher risk of developing chronic rhinosinusitis (CRS). However, there is a dearth of studies describing the factors that may be linked to the development of CRS in this population. Our objective is to identify the risk factors associated with the development of CRS in transplant recipients.

STUDY DESIGN

Retrospective cohort.

SETTING

Tertiary care center.

METHODS

This cohort included 3347 transplant recipients seen between 2017 and 2022. Of these, 2128 patients met the inclusion criteria and were grouped according to whether they were diagnosed with CRS during the post-transplant period. The analysis included both univariate and multivariate analysis to ascertain the odds ratio (OR) and predictive factors.

RESULTS

Of the 2128 patients, 649/2128 (30.4%) had CRS. CRS patients had an increased prevalence of previous endoscopic sinus surgery, allergic rhinitis, and recurrent acute rhinosinusitis in the pre-transplant period compared to the non-CRS group. According to the multivariate analysis, patients with primary immunodeficiency and additional transplant were 1.9 and 3.1 times more likely to develop CRS during the posttransplant period (95% CI: 1.3-2.6,  < .0001), (95% CI: 1.3 -7.3,  = .01), respectively. Sirolimus use was also associated with the development of CRS (OR = 1.4, 95% CI: 1.1-1.9,  = .01).

CONCLUSION

This study is the largest cohort aimed at determining the predictive factors associated with the development of CRS. Patients with pretransplant rhinologic conditions, hematologic deficiencies, and the utilization of specific immunosuppressants were found to have a higher likelihood of developing CRS following transplantation.

摘要

目的

研究表明,移植患者发生慢性鼻-鼻窦炎(CRS)的风险较高。然而,目前鲜有研究描述可能与该人群 CRS 发生相关的因素。本研究旨在确定与移植受者 CRS 发生相关的危险因素。

研究设计

回顾性队列研究。

研究地点

三级医疗中心。

方法

本队列纳入了 2017 年至 2022 年间就诊的 3347 例移植受者。其中,2128 例患者符合纳入标准,并根据其在移植后期间是否被诊断为 CRS 进行分组。分析包括单因素和多因素分析,以确定比值比(OR)和预测因素。

结果

在 2128 例患者中,649/2128(30.4%)例患有 CRS。与非 CRS 组相比,CRS 患者在移植前有更高的内镜鼻窦手术、变应性鼻炎和复发性急性鼻-鼻窦炎的患病率。根据多因素分析,原发性免疫缺陷和其他移植的患者在移植后发生 CRS 的可能性分别增加 1.9 倍和 3.1 倍(95%CI:1.3-2.6, < 0.0001),(95%CI:1.3 -7.3, = .01)。西罗莫司的使用也与 CRS 的发生相关(OR = 1.4,95%CI:1.1-1.9, = .01)。

结论

本研究是旨在确定与 CRS 发生相关的预测因素的最大队列研究。研究发现,移植前存在鼻科疾病、血液学缺陷以及使用特定免疫抑制剂的患者,在移植后发生 CRS 的可能性更高。

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