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The burden of sinus disease in cystic fibrosis lung transplant recipients
Author(s) -
Morlacchi Letizia Corinna,
Greer Mark,
Tudorache Igor,
Blasi Francesco,
Welte Tobias,
Haverich Axel,
Mainz Jochen G.,
Gottlieb Jens
Publication year - 2018
Publication title -
transplant infectious disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.69
H-Index - 67
eISSN - 1399-3062
pISSN - 1398-2273
DOI - 10.1111/tid.12924
Subject(s) - medicine , cystic fibrosis , bronchoalveolar lavage , lung transplantation , sinus (botany) , paranasal sinuses , bronchoscopy , respiratory disease , gastroenterology , lung , nasal cavity , sinusitis , pseudomonas aeruginosa , surgery , botany , genetics , bacteria , biology , genus
Sinus disease ( SD ) in cystic fibrosis ( CF ) is a known risk factor for disease progression, the upper airways ( UAW ) being a site of primary colonization with Pseudomonas aeruginosa . UAW may function as reservoir for graft colonization after lung transplantation (LuTx), increasing risk of rejection. Aims of this study were to assess the burden of sinus disease in CF LuTx recipients, considering patient‐reported symptoms, endoscopically documented signs and microbiological isolates, comparing colonization between upper and lower airways. Methods A prospective, observational study was performed on consecutive CF LuTx recipients, recording history, symptoms, and management of SD . Nasal lavage ( NL ) was evaluated for UAW colonization, with nasal inspection during bronchoscopy and bronchoalveolar lavage ( BAL ) used to assess lower airways if clinically indicated. Results Hundred and fifty‐four patients were included. Symptoms of SD were reported in 96 (62%) individuals; 87 (56%) had prior sinus surgery. Only 8 (13%) of 60 individuals undergoing bronchoscopy presented completely normal findings of the nasal cavity. Thirty‐six (60%) patients presented the same isolates on both NL and BAL . Polyps and mucosal alterations were significantly less frequently seen endoscopically in patients with normal flora in NL microbiology (respectively, 26% vs 70%, P = .003, and 35% vs 68%, P = .013). Conclusions Symptoms of SD affected more than 60% of CF LuTx recipients. Nasal endoscopic inspection identified alterations in 55%. The majority of patients presented the same isolates both on NL and BAL performed on the same visit. These results strongly support a role of paranasal sinuses as “reservoir” for descending re‐colonization of the lung graft.