Upper Airway and Otorhinolaryngologıc Complications In Renal Transplant Recipients

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.