Renal
transplantation significantly improves survival and quality of life in patients
with end-stage renal disease. However, lifelong immunosuppressive therapy
predisposes transplant recipients to a broad spectrum of infectious,
inflammatory, and neoplastic complications involving the upper airway and
otorhinolaryngologic system. Impairment of cellular immunity, disruption of
mucosal barriers, and alterations in the sinonasal microbiome contribute to
increased susceptibility to opportunistic infections and chronic inflammatory
disorders. Chronic rhinosinusitis represents the most frequently encountered
sinonasal complication, whereas invasive fungal rhinosinusitis, although less
common, remains a life-threatening condition requiring urgent diagnosis and management.
Oropharyngeal complications such as chronic pharyngitis, oral candidiasis,
aphthous ulcers, and herpes simplex infections are frequently observed and may
significantly impair nutritional status and quality of life. Otologic
manifestations, including otitis externa, otitis media, and drug-related
ototoxicity, may also occur during the post-transplant period. In addition,
prolonged immunosuppression increases the risk of head and neck malignancies
and post-transplant lymphoproliferative disorders. Early recognition of
symptoms, prompt endoscopic evaluation, radiologic imaging, and microbiological
or histopathological confirmation are essential for accurate diagnosis.
Management requires a multidisciplinary approach involving nephrologists,
otorhinolaryngologists, infectious disease specialists, and transplant
surgeons. This chapter reviews the epidemiology, pathophysiology, clinical
presentation, diagnostic evaluation, and current management strategies for
upper airway and otorhinolaryngologic complications in renal transplant
recipients.
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