IMMUNOSUPPRESSION regimens were associated with differences in sinonasal disease rates among kidney and liver transplant recipients, with basiliximab and tacrolimus-based therapy linked to higher rates of specific conditions. The multicentre analysis examined outcomes across different induction and maintenance immunosuppression strategies.
Researchers conducted a retrospective cohort study using data from 106 healthcare organisations in the USA between 1 January 2010–31 July 2025. Adult kidney and liver transplant recipients were identified and stratified according to their immunosuppression regimen.
For induction therapy, anti-thymocyte globulin (ATG) was compared with basiliximab. Maintenance therapy compared tacrolimus-based and cyclosporine-based regimens. Outcomes included sinonasal conditions and rates of functional endoscopic sinus surgery (FESS).
Basiliximab was associated with higher rates of allergic rhinitis, chronic rhinosinusitis with nasal polyposis (CRSwNP), and acute invasive fungal sinusitis compared with ATG. Reported relative risks for ATG compared with basiliximab were: allergic rhinitis (risk ratio [RR]: 0.89; 95% CI: 0.82–0.96), CRSwNP (RR: 0.62; 95% CI: 0.41–0.93), and acute invasive fungal sinusitis (RR: 0.43; 95% CI: 0.26–0.71).
Rates of FESS for chronic rhinosinusitis without nasal polyposis, CRSwNP, and acute invasive fungal sinusitis were also higher among recipients treated with basiliximab.
Tacrolimus-based maintenance therapy was associated with higher rates of allergic rhinitis compared with cyclosporine-based therapy (RR: 1.29; 95% CI: 1.10–1.51). Acute invasive fungal sinusitis was also more frequent with tacrolimus (RR: 1.73; 95% CI: 1.17–2.54).
However, surgical rates were similar between the two maintenance regimens for chronic rhinosinusitis without nasal polyposis (RR: 1.11; 95% CI: 0.60–2.05), CRSwNP (RR: 0.89; 95% CI: 0.45–1.71), and acute invasive fungal sinusitis (RR: 1.13; 95% CI: 0.57–2.20).
Overall, the findings demonstrated associations between immunosuppression regimens and specific sinonasal outcomes following kidney and liver transplantation, but because the study was retrospective, the observed differences do not establish that the regimens caused these conditions.
Further research could help clarify how treatment choices affect sinonasal health after transplantation.
Reference
Africa RE et al. Impact of kidney and liver transplant immunosuppression regimens on sinonasal disease. Am J Otolaryngology. 2026. https://doi.org/10.1016/j.amjoto.2026.104939
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