The effectiveness of tonsillectomy in diagnosing lymphoproliferative disease in pediatric patients after liver transplantation

Objective: To determine the effectiveness of diagnosing forms of lymphoprol iferative disease by performing tonsillectomy in pediatric patients who dev elop symptomatic or asymptomatic tonsillar hypertrophy during immunosuppres sive therapy after liver transplantation. Design: Retrospective chart and pathological review. Setting: Urban tertiary referral children's hospital. Main Outcome Measures: The presence of a pathological stage of lymphoprolif erative disease or Epstein-Barr virus (EBV) diagnosed using tonsillar speci mens, resulting in a change in therapy. Results: Of 275 pediatric patients who underwent liver transplantation, 13 had tonsillectomy performed with histopathological review of the tonsillar specimens. The specimens from 5 patients (39%) demonstrated pathological ch anges thought to be consistent with EBV-related changes or a form of lympho proliferative disease. Histological changes ranged from tonsillar hyperplas ia associated with EBV infection to large cell lymphoma. Immunosuppressive therapy was reduced or discontinued, and antiviral therapy was initiated. Conclusion: Children who have undergone liver transplantation and develop t onsillar hypertrophy should undergo a diagnostic tonsillectomy, regardless of the clinical presentation, to rule out a form of posttransplant lymphopr oliferative disease.