Transplant immunosuppression regimens were associated with differences in rates of sinonasal disease among adult kidney and liver transplant recipients.
In Plain English: The Clinical Takeaway
- The Core Finding: The specific anti-rejection medications patients receive after an organ transplant can influence their vulnerability to chronic sinus conditions and dangerous fungal infections.
- Induction Contrast: Basiliximab showed a higher association with sinonasal disease than anti-thymocyte globulin (ATG).
- Maintenance Differences: Among maintenance drugs, tacrolimus-based regimens presented higher relative risks for allergic rhinitis and acute invasive fungal sinusitis compared to cyclosporine-based protocols.
Investigating the TriNetX Database: Methodology and Patient Stratification
Led by researchers including Africa RE and colleagues, the retrospective cohort study evaluated extensive health records to understand how varying pharmacological approaches impact postoperative sinonasal outcomes. Utilizing the TriNetX database, the investigation analyzed data spanning from January 1, 2010, through July 31, 2025, across 106 healthcare organizations in the United States. The study stratified adult kidney and liver transplant recipients based on their distinct induction and maintenance immunosuppression protocols.
For induction therapy, the team compared anti-thymocyte globulin (ATG) against basiliximab. For long-term maintenance therapy, the evaluation contrasted tacrolimus-based regimens with cyclosporine-based regimens. Among the key clinical endpoints monitored were acute invasive fungal sinusitis (IFS), chronic rhinosinusitis with nasal polyposis (CRSwNP), allergic rhinitis (AR), chronic rhinosinusitis without nasal polyposis (CRSsNP), alongside how often functional endoscopic sinus surgery (FESS) procedures were performed.
Induction Regimens: Comparing Basiliximab and Anti-Thymocyte Globulin
The comparative analysis across induction therapies demonstrated notable variance in patient morbidity. Basiliximab was associated with higher rates of allergic rhinitis, chronic rhinosinusitis with nasal polyposis, and acute invasive fungal sinusitis when measured against anti-thymocyte globulin (ATG). For AR, CRSwNP, and acute IFS under basiliximab, the documented relative risks were 0.89 (with a 95% confidence interval of 0.82–0.96), 0.62 (0.41–0.93), and 0.43 (0.26–0.71), respectively.
Surgical intervention rates mirrored these disease distributions. Functional endoscopic sinus surgery (FESS) rates were higher among patients treated with basiliximab across multiple sinonasal pathologies. The reported relative risks for undergoing FESS were 0.60 (0.43–0.84) for CRSsNP, 0.70 (0.50–0.96) for CRSwNP, and 0.62 (0.38–0.98) for acute invasive fungal sinusitis, underscoring a heavier downstream procedural burden for this patient cohort.
Maintenance Immunosuppression: Tacrolimus Versus Cyclosporine
Beyond initial induction, the study evaluated long-term maintenance immunosuppression. Maintenance treatment utilizing tacrolimus demonstrated higher rates of allergic rhinitis and acute invasive fungal sinusitis relative to cyclosporine-based regimens. The reported relative risks stood at 1.29 (1.10–1.51) for allergic rhinitis and 1.73 (1.17–2.54) for acute invasive fungal sinusitis.
Interestingly, surgical interventions for sinonasal diseases did not display the same disparity between the two maintenance drugs. Rates of surgery for CRSsNP, CRSwNP, and acute IFS remained similar between the tacrolimus and cyclosporine treatment cohorts. For these surgical operations, the respective relative risks documented were 1.11 (0.60–2.05), 0.89 (0.45–1.71), and 1.13 (0.57–2.20).
| Immunosuppression Comparison | Sinonasal Pathology | Relative Risk (95% CI) |
|---|---|---|
| Basiliximab vs. ATG (Induction) | Allergic Rhinitis (AR) | 0.89 (0.82–0.96) |
| Basiliximab vs. ATG (Induction) | Chronic Rhinosinusitis with Nasal Polyposis (CRSwNP) | 0.62 (0.41–0.93) |
| Basiliximab vs. ATG (Induction) | Acute Invasive Fungal Sinusitis (IFS) | 0.43 (0.26–0.71) |
| Tacrolimus vs. Cyclosporine (Maintenance) | Allergic Rhinitis (AR) | 1.29 (1.10–1.51) |
| Tacrolimus vs. Cyclosporine (Maintenance) | Acute Invasive Fungal Sinusitis (IFS) | 1.73 (1.17–2.54) |
Contraindications & When to Consult a Doctor
Clinical Trajectory and Future Directions
The findings published by Africa and colleagues underscore the intricate balance required in post-transplant care, where preventing organ rejection must be weighed against the risk of opportunistic infections and inflammatory sinonasal diseases.
References
- Africa RE, et al. Impact of kidney and liver transplant immunosuppression regimens on sinonasal disease. Am J Otolaryngol. 2026;DOI:10.1016/j.amjoto.2026.104939.
Disclaimer: This article is intended for informational and educational purposes only and does not substitute for professional medical advice, diagnosis, or treatment.
