Airway inflammation and symptoms in children following liver and heart transplantation.
To describe the upper airway endoscopic findings of children with upper airway symptoms after liver transplantation (LT) or heart transplantation (HT).



Review of children undergoing airway endoscopy after LT or HT from 2011 to 2015 at a tertiary care pediatric hospital. Airway findings, biopsy results, immunosuppression, and Epstein-Barr virus (EBV) levels were recorded.



Twenty-three of 158 LT (111) and HT (47) recipients underwent endoscopy. Median time from LT to endoscopy was 9 months (range 4-25) and 31 months (range 1-108) for HT. Thirteen of 23 patients presented with upper airway symptoms, and 10/23 presented with respiratory failure or for surveillance. Thirteen patients with upper airway symptoms had abnormal findings (7 LT; 6 HT), most commonly arytenoid edema (13 patients). There were five EBV-positive biopsies (four with post-transplant lymphoproliferative disorder), and six EBV-negative biopsies with lymphocytic inflammation. One biopsy demonstrated fungal infection. Immunosuppression was decreased in seven patients, and three received steroids. There were no episodes of allograft rejection. No patients had airway symptoms at last follow-up.



In pediatric solid organ transplant recipients, symptoms of airway obstruction are not uncommon and should be evaluated with endoscopy. Endoscopy without symptoms is low-yield. Treatment with decreased immunosuppression improved airway symptoms.
Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati, Cincinnati, OH, USA.
Andrew J
0000-0003-4620-2508
AJ
Redmann
Division of Gasteroenterology, Hepatology, and Nutrition, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
John C
JC
Bucuvalas
Division of Pediatric Pulmonary Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
Robert E
RE
Wood
The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
Clifford
C
Chin
Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati, Cincinnati, OH, USA.|Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
Catherine K
CK
Hart
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D020031:Epstein-Barr Virus Infections / Q000209:etiology*; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000209:etiology; D006085:Graft Survival; D016027:Heart Transplantation / Q000009:adverse effects*; D004854:Herpesvirus 4, Human / Q000472:pathogenicity; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007249:Inflammation / Q000209:etiology*; D016031:Liver Transplantation / Q000009:adverse effects*; D008232:Lymphoproliferative Disorders / Q000209:etiology*; D008297:Male; D011183:Postoperative Complications; D011379:Prognosis; D012140:Respiratory Tract Diseases / Q000209:etiology*; D012307:Risk Factors