Chronic infection with Pseudomonas aeruginosa in cystic fibrosis: a risk factor for nasal polyposis after lung transplantation.

Background: Nasal polyposis (NP) is common in cystic fibrosis (CF) patients. The prevalence of the CF phenotype with NP after lung transplantation (LTx) is unknown. Risk factors for the development of NP after LTx are not well described.

Methods: CF patients with LTx at our center between November 1992 and December 2009 were included. They were regularly investigated with nasal endoscopy and aspiration of sinus secretions with microbiological evaluation. Patients with and without development of NP were compared along the following parameters: gender, age, dF508, diabetes, acute rejection, NP at LTx, and microbiology of the sinuses before and after LTx. A multivariate Cox regression analysis was performed.

Results: The study included 94 patients; 21 were excluded because of incomplete data. Thirty-five (48%) of the remaining 73 patients developed NP. Mean time to diagnosis of NP was 4.2 (2.9-5.6) years after LTx. Prevalence of NP was 11% after the first year and 18%, 33%, and 44% after the first 2, 5, and 10 years, respectively. Patients with posttransplantation NP were younger, had NP before LTx, and were chronically infected with Pseudomonas aeruginosa (PA) in the nose. Multivariate analysis demonstrated that chronic infection with PA was the only significant risk factor for the development of nasal polyps after LTx (hazards ratio, 7.2; 95% confidence interval, 2.1-24.2; P=0.001).

Conclusions: In contrast to pretransplantation patients, NP is more common after LTx. Development of NP occurs throughout the whole observation time. Chronic sinonasal PA infection seems to be the only significant risk factor for NP after LTx.