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Background/aim <p>Cystic fibrosis (CF) is an autosomal recessive disorder resulting from CFTR gene mutations, leading to thick, viscous mucus secretions that impair respiratory function and increase susceptibility to infections. Lung transplantation is the primary treatment for end-stage respiratory failure in CF patients; however, bacterial colonization of the sinuses, particularly by Pseudomonas aeruginosa, poses a significant risk for post-transplant complications. Endoscopic sinus surgery (ESS) has been proposed as a preventive strategy to reduce bacterial load before transplantation. This study aims to systematically evaluate the clinical effects of ESS in CF patients undergoing lung transplantation.</p> Methods <p>A systematic review and meta-analysis adhering to PRISMA guidelines was conducted. Databases searched included PubMed, Scopus, Embase, Cochrane, and Web of Science. Studies assessing the role of ESS in CF patients undergoing lung transplantation were included. Data were analyzed using R version 4.3.1, and heterogeneity was assessed using τ², I², and Q-tests.</p> Results <p>The search identified 18 studies (1 prospective, 13 retrospective, 4 case reports) meeting the inclusion criteria. The included studies encompassed 763 patients (ages 11–57 years). The impact of comprehensive ESS performed before, during, or after lung transplantation was investigated in 612 patients to assess infectious complications and allograft dysfunction. Meta-analysis revealed significant reductions in antibiotic use (SMD = − 0.81, <i>p</i> = 0.002) and hospital stay duration (SMD = − 0.76, <i>p</i> = 0.031) with low-to-moderate heterogeneity. SNOT-22 scores and FEV1 showed no significant changes. Infection rates varied, with Pseudomonas aeruginosa being the most common pathogen in BAL (58.1%) and sinus aspirates (52.1%). Significant heterogeneity in infection proportions was observed.</p> Conclusion <p>ESS before lung transplantation in CF patients appears to reduce antibiotic utilization and hospital stay duration. However, it did not demonstrate a statistically significant improvement in post-transplant lung function (FEV1) in this analysis. While promising, further prospective randomized studies are needed to confirm these findings and establish standardized ESS protocols for pre-transplant CF management.</p>

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Endoscopic sinus surgery for lung transplanted cystic fibrosis patients: a systematic review and meta-analysis

  • 期刊论文

  • 发表日期：

    2026年4月6日

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  • Sinem Nur Ertan,
  • Omar Alomari,
  • Muhammed Edib Mokresh,
  • Habiba Eyvazova,
  • Beyzanur Guney,
  • Cagla Sumeyye Caliskan,
  • Rumeysa Yegin,
  • Serdar Evman,
  • Melis Demirag Evman

摘要

Background/aim

Cystic fibrosis (CF) is an autosomal recessive disorder resulting from CFTR gene mutations, leading to thick, viscous mucus secretions that impair respiratory function and increase susceptibility to infections. Lung transplantation is the primary treatment for end-stage respiratory failure in CF patients; however, bacterial colonization of the sinuses, particularly by Pseudomonas aeruginosa, poses a significant risk for post-transplant complications. Endoscopic sinus surgery (ESS) has been proposed as a preventive strategy to reduce bacterial load before transplantation. This study aims to systematically evaluate the clinical effects of ESS in CF patients undergoing lung transplantation.

Methods

A systematic review and meta-analysis adhering to PRISMA guidelines was conducted. Databases searched included PubMed, Scopus, Embase, Cochrane, and Web of Science. Studies assessing the role of ESS in CF patients undergoing lung transplantation were included. Data were analyzed using R version 4.3.1, and heterogeneity was assessed using τ², I², and Q-tests.

Results

The search identified 18 studies (1 prospective, 13 retrospective, 4 case reports) meeting the inclusion criteria. The included studies encompassed 763 patients (ages 11–57 years). The impact of comprehensive ESS performed before, during, or after lung transplantation was investigated in 612 patients to assess infectious complications and allograft dysfunction. Meta-analysis revealed significant reductions in antibiotic use (SMD = − 0.81, p = 0.002) and hospital stay duration (SMD = − 0.76, p = 0.031) with low-to-moderate heterogeneity. SNOT-22 scores and FEV1 showed no significant changes. Infection rates varied, with Pseudomonas aeruginosa being the most common pathogen in BAL (58.1%) and sinus aspirates (52.1%). Significant heterogeneity in infection proportions was observed.

Conclusion

ESS before lung transplantation in CF patients appears to reduce antibiotic utilization and hospital stay duration. However, it did not demonstrate a statistically significant improvement in post-transplant lung function (FEV1) in this analysis. While promising, further prospective randomized studies are needed to confirm these findings and establish standardized ESS protocols for pre-transplant CF management.