Impact of kidney and liver transplant immunosuppression regimens on sinonasal disease

Objective: To compare differences in the rate of chronic rhinosinusitis with or without nasal polyposis (CRSwNP, CRSsNP), allergic rhinitis (AR), and acute invasive fungal sinusitis (IFS) among kidney and liver transplant patients following different immunosuppression regimens. Methods: This is a multicenter, retrospective cohort study utilizing data from the TriNetX database from January 1, 2010 to July 31, 2025. Data are derived from 106 healthcare organizations in the United States. Adult kidney and liver transplant recipients were identified and stratified by induction and maintenance immunosuppression. Induction therapy compared anti-thymocyte globulin (ATG) with basiliximab, and maintenance therapy compared a tacrolimus-based regimen with a cyclosporine-based regimen. Outcomes and rates of functional endoscopic sinus surgery were assessed. Results: Treatment with basiliximab was associated with a higher rate of AR, CRSwNP, and acute IFS following induction treatment compared to ATG (RR: 0.89 [0.82–0.96]; 0.62 [0.41–0.93]; 0.43 [0.26–0.71]). The rates of FESS to address CRSsNP, CRSwNP, and acute IFS were also higher in group treated with basiliximab (RR: 0.60 [0.43–0.84]; 0.70 [0.50–0.96]; 0.62 [0.38–0.98]). Maintenance therapy with tacrolimus was associated with higher rates of AR and acute IFS compared to cyclosporine (RR: 1.29 [1.10–1.51]; 1.73 [1.17–2.54]). The rates of surgery for CRSsNP, CRSwNP, and acute IFS following maintenance therapy were similar between those treated tacrolimus and cyclosporine (RR: 1.11 [0.60–2.05]; 0.89 [0.45–1.71]; 1.13 [0.57–2.20]). Conclusion: When comparing common immunosuppression for kidney and liver transplant, basiliximab was associated with a higher rate of sinonasal disease and AR compared to ATG. For maintenance immunosuppression, treatment with tacrolimus-based regimens was associated with a higher rate of AR and acute IFS. Level of evidence: Level 3.