Sinonasal disease in lung transplant recipients: A retrospective study at a single lung-transplant center in Japan

OBJECTIVE: Infectious complications are a leading cause of morbidity and mortality post-lung transplantation. Chronic rhinosinusitis (CRS) frequently occurs in patients with conditions that are common indications for lung transplantation. Proactive management of sinonasal disease may help to reduce airway colonization and improve clinical outcomes after lung transplantation, but CRS prevalence, clinical features, and management strategies in lung transplant recipients are poorly studied. Thus, we sought to clarify the prevalence, clinical characteristics, and management strategies of chronic rhinosinusitis (CRS) among lung transplant recipients at a single lung-transplant center in Japan, with particular attention to regional differences in disease etiology and management. METHODS: We included 272 patients who underwent or were scheduled to undergo lung transplantation at the University of Tokyo Hospital between 2015 and 2024. Patient demographics, underlying respiratory diseases, pre- or posttransplant sinonasal status, and otolaryngological management data were collected. CRS was diagnosed based on the EPOS 2020 criteria, which incorporate clinical symptoms, endoscopic findings, and radiological evidence. We evaluated CRS prevalence and its associations with specific pulmonary diagnoses, surgical intervention rates, and clinical outcomes. RESULTS: CRS was identified in 7.2 % (16/222) of pre-transplant and 13.8 % (8/58) of post-transplant patients. Significantly higher CRS prevalence was observed in patients with bronchiectasis (53.8 %, odds ratio [OR] 17.7, p < 0.001) and diffuse panbronchiolitis (60.0 %, OR 18.5; p = 0.005), suggesting that ciliary dysfunction is a major risk factor for CRS. Imaging predominantly revealed maxillary and ethmoid sinus involvement. Fungal balls were noted in approximately 10 % of patients. Endoscopic sinus surgery was performed in refractory CRS cases, which resulted in good postoperative outcomes, with preservation of lung graft function and absence of surgery-related complications and opportunistic infections. Although based on a limited number of surgical cases, histopathological examination of the surgical specimens revealed a predominance of neutrophilic and non-eosinophilic inflammation. CONCLUSION: CRS is a clinically significant and relatively common complication in Japanese lung transplant recipients, particularly in those with underlying ciliary dysfunction. These findings highlight distinct regional differences in disease phenotypes and management approaches for CRS in lung transplant recipients. Systematic otolaryngological evaluation and timely intervention for CRS, including endoscopic sinus surgery, may help to prevent severe infections and optimize post-lung transplant outcomes.