The burden of sinus disease in cystic fibrosis lung transplant recipients

Letizia Corinna Morlacchi, Mark Greer, Igor Tudorache, Francesco Blasi, Tobias Welte, Axel Haverich, Jochen G. Mainz, Jens Gottlieb

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Introduction: 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.

Original languageEnglish
Article numbere12924
JournalTransplant Infectious Disease
Volume20
Issue number5
DOIs
Publication statusPublished - Oct 1 2018

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Nasal Lavage
Cystic Fibrosis
Bronchoalveolar Lavage
Lung
Bronchoscopy
Nose
Transplants
Lung Transplantation
Paranasal Sinuses
Nasal Cavity
Disease Management
Polyps
Microbiology
Pseudomonas aeruginosa
Observational Studies
Disease Progression
History
Transplant Recipients
Prospective Studies

Keywords

  • airway colonization
  • chronic rhinosinusitis
  • cystic fibrosis
  • lung transplantation
  • sinus disease
  • upper airways

ASJC Scopus subject areas

  • Transplantation
  • Infectious Diseases

Cite this

Morlacchi, L. C., Greer, M., Tudorache, I., Blasi, F., Welte, T., Haverich, A., ... Gottlieb, J. (2018). The burden of sinus disease in cystic fibrosis lung transplant recipients. Transplant Infectious Disease, 20(5), [e12924]. https://doi.org/10.1111/tid.12924

The burden of sinus disease in cystic fibrosis lung transplant recipients. / Morlacchi, Letizia Corinna; Greer, Mark; Tudorache, Igor; Blasi, Francesco; Welte, Tobias; Haverich, Axel; Mainz, Jochen G.; Gottlieb, Jens.

In: Transplant Infectious Disease, Vol. 20, No. 5, e12924, 01.10.2018.

Research output: Contribution to journalArticle

Morlacchi, LC, Greer, M, Tudorache, I, Blasi, F, Welte, T, Haverich, A, Mainz, JG & Gottlieb, J 2018, 'The burden of sinus disease in cystic fibrosis lung transplant recipients', Transplant Infectious Disease, vol. 20, no. 5, e12924. https://doi.org/10.1111/tid.12924
Morlacchi, Letizia Corinna ; Greer, Mark ; Tudorache, Igor ; Blasi, Francesco ; Welte, Tobias ; Haverich, Axel ; Mainz, Jochen G. ; Gottlieb, Jens. / The burden of sinus disease in cystic fibrosis lung transplant recipients. In: Transplant Infectious Disease. 2018 ; Vol. 20, No. 5.
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AU - Morlacchi, Letizia Corinna

AU - Greer, Mark

AU - Tudorache, Igor

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AU - Welte, Tobias

AU - Haverich, Axel

AU - Mainz, Jochen G.

AU - Gottlieb, Jens

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N2 - Introduction: 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.

AB - Introduction: 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.

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