Patterns in Timing of Otolaryngology Evaluation Following Hematopoietic and Solid Organ Transplantation: A Multicenter Study

Introduction: Sinonasal disease is frequently experienced by transplant recipients, yet differences in patterns of otolaryngology evaluation after transplantation are unknown. We aimed to characterize timing patterns to first comprehensive otolaryngology assessment for sinonasal disease across transplant populations.

Methods: We conducted a retrospective cohort study of adult transplant recipients without pre-transplant sinonasal disease undergoing transplantation at three tertiary care centers through 2024. A composite sinonasal event was defined using symptom reports, documented sinus infection, and diagnostic fields. Patients were followed from transplant through 120 months for time to first comprehensive otolaryngology evaluation. Kaplan-Meier and multivariable Cox-regression models were used to evaluate differences between solid-organ (SOT) and hematopoietic stem cell transplantation (HSCT).

Results: Among 1,440 transplant recipients (570 HSCT, 870 SOT), sinonasal events were observed in 388 HSCT patients (68.1%) and 536 SOT patients (61.6%). The most prevalent symptoms were nasal obstruction (43.8%), rhinorrhea (33.8%), and facial pain (31.4%). Of 1,405 patients included in time-to-event analyses, comprehensive otolaryngology evaluation occurred in 248 HSCT recipients (45.1%) and 303 SOT recipients (35.4%). Median time to evaluation was shorter following HSCT than SOT (60.7 vs 91.5 months). In adjusted analyses, HSCT recipients had higher cumulative incidence and earlier evaluation (aHR 1.56; p< 0.001). In exploratory analyses, graft-versus-host disease among HSCT recipients was associated with increased evaluation rates (p=0.002), whereas rejection and number of immunosuppressants were not significantly associated.

Conclusions: Otolaryngology evaluation for sinonasal disease appears to occur earlier and more frequently in HSCT compared to SOT. These findings support transplant-specific surveillance strategies for earlier ENT involvement to mitigate sinonasal morbidity.