Immunohistochemical analysis and Epstein-Barr virus in the tonsils of transplant recipients and healthy controls.
OBJECTIVE
To compare lymphocyte immunohistochemical markers and staining for Epstein-Barr virus (EBV) in tonsillectomy specimens from healthy children and pediatric transplant recipients.


METHODS
Analysis of pathology specimens.


METHODS
Tertiary care medical center.


METHODS
Consecutive sample of tonsillectomy specimens from 60 pediatric solid organ transplant recipients and 60 healthy children.


METHODS
Immunohistochemical staining of tonsillectomy specimens for kappa and lambda light chains, B and T lymphocytes, EBV-encoded small nuclear RNA (EBV-EBER), and EBV-encoded latent membrane protein (EBV-LMP).


METHODS
Detection of a difference in EBV activity in transplant recipients vs healthy controls.


RESULTS
There was 1 case of posttransplantation lymphoproliferative disorder (PTLD). All other tonsillectomy specimens from both groups demonstrated follicular hyperplasia. Tonsillectomy specimens from both groups were polyclonal, expressing kappa and lambda light-chain activity, including the case of PTLD. The number of specimens staining positive for CD3 activity, a marker of T lymphocytes, was reduced in the transplant group (85%), compared with 100% in the control group (P < .01). EBV-EBER is a nuclear stain indicating active EBV infection, whereas EBV-LMP staining denotes latent infection. Twenty-seven of 60 transplant specimens (45%) demonstrated EBV-EBER activity compared with 0 of 60 control specimens (P < .001). EBV-LMP activity was equal in both groups.


CONCLUSIONS
Adenotonsillar hypertrophy in transplant recipients with no prior exposure to EBV may be a sign of active EBV infection. A high incidence of EBV-EBER was found in the tonsils of transplant recipients. Active adenotonsillar EBV infection in the setting of T-lymphocyte suppression in transplant recipients may be a potential early precursor of PTLD.
Mowry
Sarah E
SE
Division of Otolaryngology-Head and Neck Surgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095-1624, USA.
Strocker
Ali M
AM
Chan
Jessica
J
Takehana
Christopher
C
Kalantar
Nader
N
Bhuta
Sunita
S
Shapiro
Nina L
NL
D000293:Adolescent; D000328:Adult; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D020031:Epstein-Barr Virus Infections / Q000175:diagnosis*; D005260:Female; D004854:Herpesvirus 4, Human / Q000302:isolation & purification*; D006801:Humans; D007150:Immunohistochemistry; D007223:Infant; D016030:Kidney Transplantation; D016031:Liver Transplantation; D008232:Lymphoproliferative Disorders / Q000175:diagnosis; D008297:Male; D014066:Palatine Tonsil / Q000473:pathology / Q000821:virology*; D011184:Postoperative Period; D012189:Retrospective Studies; D014068:Tonsillectomy