Adenotonsillar enlargement in pediatric patients following solid organ transplantation.
OBJECTIVE
To evaluate the management of adenotonsillar hypertrophy in pediatric patients after transplantation.


METHODS
A retrospective medical record review after transplantation of all pediatric patients undergoing adenotonsillectomy at the University of California, Los Angeles, Medical Center during a 14-month period.


METHODS
A tertiary care center.


METHODS
There were 16 patients in our review, 11 boys and 5 girls. Nine patients had undergone liver transplantation, and 7 had undergone kidney transplantation.


METHODS
Fourteen patients underwent adenotonsillectomy, and 2 underwent adenoidectomy alone. Indications for surgical intervention included progressive symptoms of upper airway obstruction, recurrent tonsillitis, and/or evidence of notable adenotonsillar enlargement on physical examination.


RESULTS
The mean +/- SD age at the time of transplantation was 3 years 1 month +/- 3 years 5 months. The mean +/- SD duration from allograft transplantation to adenotonsillectomy was 5 years 1 month +/- 2 years 4 months. Histopathologic examination revealed that 1 kidney transplant recipient had posttransplantation lymphoproliferative disorder. Eleven patients were found to have Epstein-Barr virus-related lymphoid hyperplasia. All patients experienced clinical resolution of their symptoms after surgery.


CONCLUSIONS
Posttransplantation lymphoproliferative disorder is a condition associated with the Epstein-Barr virus infection in the setting of immunosuppression. Early presentation of posttransplantation lymphoproliferative disorder in children may be manifested by adenotonsillar enlargement. In addition to the role in relieving upper airway obstruction and decreasing upper respiratory tract infection, adenotonsillectomy may be critical in the prompt evaluation and treatment of posttransplantation lymphoproliferative disorder.
Huang
R Y
RY
Department of Surgery, University of California, Los Angeles, UCLA School of Medicine, 90095-1624, USA.
Shapiro
N L
NL
D000234:Adenoids / Q000473:pathology*; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D020031:Epstein-Barr Virus Infections / Q000175:diagnosis; D005260:Female; D006801:Humans; D006984:Hypertrophy; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016030:Kidney Transplantation / Q000009:adverse effects*; D016031:Liver Transplantation / Q000009:adverse effects*; D008232:Lymphoproliferative Disorders / Q000175:diagnosis / Q000209:etiology* / Q000473:pathology / Q000628:therapy; D008297:Male; D014066:Palatine Tonsil / Q000473:pathology*; D012189:Retrospective Studies; D012307:Risk Factors
D007166:Immunosuppressive Agents