COMPLICATIONS - INFECTIONS

D. Lang-loidolt¹, A. Neuschitzer², P.V. Tomaciz^2
1Ent-department, Medical University of Graz, Graz/AUSTRIA, ²Ent, Medical University of Graz, Graz/AUSTRIA

Body: Background: Organ transplantation is associated with life-long immunosuppressive therapies. To minimize the risk of post-transplant infections all our patients are screened for paranasal sinus diseases by PNS-CT scans. This evaluation is done, regardless of presence of symptoms of acute or chronic paranasal sinus diseases. Surgical treatment in patients suffering from clotting disorders like those who are planned for liver transplantation or those who have to be anti-coagulized for heart disorders, is challenging. Besides other risks, bleeding during functional endoscopic surgery may be increased and life-threatening. Functional endoscopic sinus surgery (FESS) is performed in patients suffering from chronic sinusitis confirmed in PNS-CT-scans. On the one hand treatment of symptom free patients with pathological CT scans might not be necessary, on the other hand “silent” sinusitis might exacerbate to life-threatening conditions under immunosuppressive treatment. Up to now we do not have any data if FESS in transplant patients prior to transplantation, regardless of presence or absence symptoms, is necessary and paranasal sinus infections after organ transplantation can be prevented. In this presentation we will show data of PNS-CT scans of patients who had been planned for or already had organ transplantation Material & Methods: PNS-CT scans of transplant patients (6/2000-3/2009) were retrospectively evaluated according to the Lund-MacKay staging system (1993). Frequency of pathologic PNS-CT scans for different entities leading to transplantation and underlying ENT diseases were determined. Results: 173 CT scans in patients (137 male/ 32 female, 16-72 years old) performed between 1/2002 and 3/2009 were evaluated. 144 had been done before, 29 after transplantation. About 81% of patients planned for TX do not suffer from PNS diseases. In contrast only 36 % of TX patients show normal PNS CT scans. Pathologic tissue swelling was observed one side most frequently in PNS-healthy patients (P<0.05), in both sides most frequently in patients suffering from PNS diseases (P<0.001). Minimal sinusitis according to CT score was observed most frequently in patients without PNS symptoms (P<0.001). In PNS diseased patients moderate sinusitis according to CT scans were most frequent (P<0.001). No correlations with planned transplantations were observed in PNS symptoms and CT scans. Conclusion: Our data demonstrate the very conflicting situation in transplant patients. Nearly two thirds of patients show pathologic PNS CT scans, whereas about 80% of those are without any symptoms of paranasal sinus diseases. Perspective: According to these results a prospective randomized study will be conducted in order to prove, whether or not FESS is necessary in symptom free patients showing pathologic CT scans.

Disclosure: All authors have declared no conflicts of interest.