Adenotonsillar enlargement in pediatric patients following solid organ transplantation.

OBJECTIVE To evaluate the management of adenotonsillar hypertrophy in pediatric patients after transplantation. DESIGN A retrospective medical record review after transplantation of all pediatric patients undergoing adenotonsillectomy at the University of California, 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 patients had undergone liver transplantation, and 7 had undergone kidney transplantation. INTERVENTION Fourteen patients underwent adenotonsillectomy, and 2 underwent adenoidectomy alone. Indications for surgical intervention included progressive 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 month +/- 3 years 5 months. The mean +/- SD duration from allograft transplantation to adenotonsillectomy was 5 years 1 month +/- 2 years 4 months. Histopathologic examination revealed that 1 kidney transplant recipient had posttransplantation lymphoproliferative disorder. Eleven patients were found to have Epstein-Barr virus-related lymphoid hyperplasia. All patients experienced clinical resolution of their symptoms after surgery. CONCLUSIONS Posttransplantation lymphoproliferative disorder is a condition associated with the Epstein-Barr virus infection in the setting of immunosuppression. Early presentation of posttransplantation lymphoproliferative disorder in children may be manifested by adenotonsillar enlargement. In addition to the role in relieving upper airway obstruction and decreasing upper respiratory tract infection, adenotonsillectomy may be critical in the prompt evaluation and treatment of posttransplantation lymphoproliferative disorder.