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Risk factors for adenotonsillar hypertrophy in children following solid organ transplantation
Nina L Shapiro1, Ali M Strocker, Neil Bhattacharyya
1Division of Head and Neck Surgery, UCLA School of Medicine, 62-158 CHS, 10833 LeConte Avenue, Los Angeles, CA 90095, USA. nshapiro@ucla.edu
Insights
Younger age and Epstein-Barr virus (EBV) seronegativity are key risk factors for adenotonsillar hypertrophy (ATH) in pediatric solid organ transplant recipients. ATH may precede PTLD, necessitating ongoing surveillance.
Area of Science:
- Pediatric Transplant Medicine
- Immunology
- Otolaryngology
Background:
- Post-transplantation lymphoproliferative disorder (PTLD) and its precursor, Epstein-Barr virus (EBV)-related lymphoid hyperplasia, can manifest in the tonsils and adenoids of pediatric solid organ transplant recipients.
- Adenotonsillar hypertrophy (ATH) may represent an early sign of PTLD in this vulnerable population.
Purpose of the Study:
- To identify clinical signs, symptoms, and risk factors associated with adenotonsillar hypertrophy (ATH) in children following solid organ transplantation.
- To investigate the relationship between ATH and potential precursors to PTLD.
Main Methods:
- A cross-sectional study was conducted with 132 pediatric solid organ transplant patients.
- Data were collected through questionnaires, physical examinations, and laboratory tests.
- Statistical analysis, including correlation and multivariate linear regression, was used to identify risk factors for ATH.
Main Results:
- The study included 132 pediatric transplant recipients (64 renal, 68 liver) with a mean follow-up of 49 months.
- A significant correlation was found between questionnaire scores and physical examination findings for ATH (Pearson's r=0.352, P<0.001).
- Recipient EBV seronegativity and younger age at transplantation were identified as significant risk factors for ATH (P=0.024 and P=0.035, respectively).
Conclusions:
- Younger age at transplantation and EBV seronegativity are significant risk factors for developing ATH in pediatric solid organ transplant recipients.
- ATH may be an early indicator of PTLD, highlighting the need for long-term patient surveillance.
- Further research is required to understand the impact of ATH on the quality of life and survival rates in these pediatric patients.
Objective:
Post-transplantation lymphoproliferative disorder (PTLD), or its precursor, Epstein-Barr virus (EBV)-related lymphoid hyperplasia, may first present in the tonsils and adenoids in the pediatric solid organ transplant population. We sought to identify signs and symptoms of and risk factors for adenotonsillar hypertrophy (ATH), a potential precursor to PTLD in children following solid organ transplantation.
Methods:
We performed a cross-sectional study of 132 consecutive pediatric solid organ transplant patients at our institution. Questionnaire, physical examination, and laboratory data collection were obtained. Correlation of signs and symptoms of ATH with objective laboratory data was conducted.
Results:
132 pediatric transplant recipients (64 renal, 68 liver) were enrolled. Mean age at transplantation was 7.4 (S.D. 6.0) years with a mean follow-up of 49.0 (S.D. 48.4) months post-transplantation. The mean questionnaire score was 8.4 (S.D. 7.9) out of a maximum 65 and the mean physical examination score was 3.9 (S.D. 1.9) out of a maximum 8, with a statistically significant correlation between the two (Pearson's r=0.352, P<0.001). A multivariate linear regression model found recipient EBV seronegativity and younger age at transplantation to be statistically significant risk factors for development of ATH (P=0.024 and 0.035, respectively).
Conclusions:
Young age and EBV seronegativity confer increased risk for ATH in pediatric patients undergoing solid organ transplantation. As ATH may be the earliest sign of PTLD, long-term surveillance is required to determine the impact of ATH on quality of life and survival in these patients.