Adenotonsillar enlargement in pediatric patients following solid organ transplantation

Objective: To evaluate the management of adenotonsillar hypertrophy in pedi atric patients after transplantation. Design: A retrospective medical record review after transplantation of all pediatric patients undergoing adenotonsillectomy at the University of Calif ornia, Los Angeles, Medical Center during a 14-month period. Setting: A tertiary care center. Patients: There were 16 patients in our review, 11 boys and 5 girls. Nine p atients had undergone liver transplantation, and 7 had undergone kidney tra nsplantation Intervention: Fourteen patients underwent adenotonsillectomy, and 2 underwe nt adenoidectomy alone. Indications for surgical intervention included prog ressive 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 m onth +/- 3 years 5 months. The mean +/- SD duration from allograft transpla ntation to adenotonsillectomy was 5 years 1 month +/- 2 years 4 months. His topathologic examination revealed that 1 kidney transplant recipient had po sttransplantation lymphoproliferative disorder. Eleven patients were found to have Epstein-Barr virus-related lymphoid hyperplasia. All patients exper ienced clinical resolution of their symptoms after surgery. Conclusions: Posttransplantation lymphoproliferative disorder is a conditio n associated with the Epstein-Barr virus infection in the setting of immuno suppression. Early presentation of posttransplantation lymphoproliferative disorder in children may be manifested by adenotonsillar enlargement. In ad dition to the role in relieving upper airway obstruction and decreasing upp er respiratory tract infection, adenotonsillectomy may be critical in the p rompt evaluation and treatment of posttransplantation lymphoproliferative d isorder.