Histopathologic Analysis of Chronic Rhinosinusitis in Immunosuppressed Transplant Patients

Background Immunosuppressed organ transplant recipients experience higher rates of medically refractory chronic rhinosinusitis (CRS) requiring endoscopic sinus surgery (ESS). Objective To better understand the pathogenesis of CRS in immunosuppressed organ transplant recipients to aid in developing effective treatment protocols. Methods Structured histopathology (SHP) reports of sinonasal mucosa were obtained for 27 transplant and 505 nontransplant patients with CRS undergoing ESS. SHP reports were compared to identify differences in the inflammatory environment between the 2 groups. Results SHP analysis revealed significantly higher rates of neutrophil infiltrate (48.1% vs 10.7%, P < .001), basement membrane thickening (74.1% vs 30.9%, P < .001), subepithelial edema (85.2% vs 25.7%, P < .001), and fibrosis (37.0% vs 16.8%, P = .008) in the sinus tissue of transplant patients compared to nontransplant patients, respectively. Conclusion CRS patients with a history of organ transplant overall displayed higher tissue neutrophilia and extensive tissue modeling on SHP. This patient population could potentially benefit from treatment modalities that are comparable to those used in patients with non-type 2 CRS.