Adenotonsillar hypertrophy and Epstein-Barr virus in pediatric organ transplant recipients

Objectives/Hypothesis: Epstein-Barr virus-related (EBV-related) lymphoid hy perplasia of the tonsils and adenoids is a precursor to post-transplantatio n lymphoproliferative disorder (PTLD), The incidence of posttransplantation adenotonsillar hypertrophy, a potential early sign of PTLD or EBV-related lymphoid hyperplasia, is not known, We sought to identify potential risk fa ctors for adenotonsillar hypertrophy manifested as EBV related hyperplasia and early PTLD in the pediatric solid organ transplant population. Study De sign: Cross-sectional analysis. Methods: We developed a 65-point questionna ire concerning obstructive sleep disorder and upper respiratory tract infec tions and an 8-point focused physical examination, to identify prevalence o f and risk factors for adenotonsillar hypertrophy in the pediatric transpla nt population. We evaluated 120 pediatric solid organ transplant recipients by parental questionnaire and focused adenotonsillar physical examination. Results: Of the 120 patients, 62 had undergone Liver transplantation and 5 8 had undergone kidney transplantation, Overall, the mean questionnaire sco re was 8.36 (range, 0-40) and the mean physical examination score was 3.86 (range, 1-8), Patients whose EBV serological test result was negative at th e time of transplant had higher scores for both the questionnaire (mean sco re, 10.24) and the physical examination (mean score, 4.56) than those whose EBV serological test result was positive at the time of transplantation (s cores of 7.38 and 3.30 for questionnaire and physical examination, respecti vely). The difference in examination scores was statistically significant ( P < .003), Conclusions: Epstein-Barr virus seronegativity at the time of or gan transplantation is a known risk factor for PTLD, with associated risk o f developing EBV-related lymphoid hyperplasia. Our results indicate a highe r incidence of symptoms and signs consistent with adenotonsillar hypertroph y in the EBV seronegative population. Adenotonsillar hypertrophy may be a p recursor to EBV-related lymphoid hyperplasia and PTLD and must be identifie d in this patient population.