Researchers found that basiliximab induction therapy and tacrolimus-based maintenance treatments correlated with higher rates of specific nasal and sinus complications compared with alternative drug classes.
Transplant Induction Therapies: Basiliximab Versus ATG
Led by Africa RE and colleagues, the study analyzed health data from the TriNetX database covering 106 healthcare organizations in the United States between January 1, 2010, and July 31, 2025. Investigators stratified adult kidney and liver transplant recipients based on their induction and maintenance regimens. For induction therapy, the team compared basiliximab against anti-thymocyte globulin (ATG).
The findings indicate that basiliximab is associated with higher rates of allergic rhinitis, chronic rhinosinusitis with nasal polyposis (CRSwNP), and acute invasive fungal sinusitis (IFS) following induction treatment. Specifically, reported relative risks for basiliximab compared with ATG stood at 0.89 for allergic rhinitis, 0.62 for CRSwNP, and 0.43 for acute invasive fungal sinusitis. Rates of functional endoscopic sinus surgery (FESS) remained elevated among patients treated with basiliximab for chronic rhinosinusitis without nasal polyposis, CRSwNP, and acute invasive fungal sinusitis, with relative risks recorded at 0.60, 0.70, and 0.62, respectively.
Maintenance Immunosuppression: Tacrolimus Compared With Cyclosporine
For maintenance therapy, the multicenter investigation contrasted tacrolimus-based regimens with cyclosporine-based protocols. Maintenance treatment utilizing tacrolimus correlated with elevated rates of allergic rhinitis and acute invasive fungal sinusitis compared to cyclosporine.
The reported relative risks reached 1.29 for allergic rhinitis and 1.73 for acute invasive fungal sinusitis among patients receiving tacrolimus. However, surgical intervention rates for chronic rhinosinusitis without nasal polyposis, CRSwNP, and acute invasive fungal sinusitis showed no significant divergence between the tacrolimus and cyclosporine treatment cohorts. The authors concluded that drug selection in both induction and maintenance phases shapes sinonasal outcomes for solid organ transplant recipients.
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