TRANSPLANT immunosuppression regimens were associated with differences in sinonasal disease among adults receiving kidney or liver transplants, with basiliximab linked to higher rates of allergic rhinitis, chronic rhinosinusitis and acute invasive fungal sinusitis than anti-thymocyte globulin (ATG).
The multicentre retrospective cohort study used data from the TriNetX database covering 106 healthcare organisations in the United States between 1 January 2010 and 31 July 2025. Adult kidney and liver transplant recipients were stratified according to induction and maintenance immunosuppression.
For induction therapy, the researchers compared ATG with basiliximab. Maintenance therapy was compared between tacrolimus-based and cyclosporine-based regimens. The study assessed rates of allergic rhinitis (AR), chronic rhinosinusitis with nasal polyposis (CRSwNP), chronic rhinosinusitis without nasal polyposis (CRSsNP), acute invasive fungal sinusitis (IFS) and functional endoscopic sinus surgery (FESS).
Basiliximab was associated with higher rates of AR, CRSwNP and acute IFS following induction treatment compared with ATG. The reported relative risks were: 0.89 (0.82–0.96) for AR; 0.62 (0.41–0.93) for CRSwNP; and 0.43 (0.26–0.71) for acute IFS.
Rates of FESS were also higher among patients treated with basiliximab for CRSsNP, CRSwNP and acute IFS. The reported relative risks were: 0.60 (0.43–0.84); 0.70 (0.50–0.96); and 0.62 (0.38–0.98), respectively.
Maintenance treatment with tacrolimus was associated with higher rates of AR and acute IFS than cyclosporine. The reported relative risks were: 1.29 (1.10–1.51) for AR and 1.73 (1.17–2.54) for acute IFS.
Rates of surgery for CRSsNP, CRSwNP and acute IFS were similar between tacrolimus and cyclosporine treatment groups, with reported relative risks of 1.11 (0.60–2.05), 0.89 (0.45–1.71) and 1.13 (0.57–2.20), respectively.
The findings suggest that the choice of transplant immunosuppression may be associated with differing sinonasal outcomes. The authors concluded that basiliximab was associated with higher rates of sinonasal disease and AR compared with ATG, while tacrolimus-based maintenance regimens were associated with higher rates of AR and acute IFS compared with cyclosporine.
Reference
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.
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