Adenotonsillar pathology in post-transplant patients

The purpose of this study is to evaluate the efficacy of adenotonsillar hypertrophy, Epstein-Barr virus (EBV) titers, and flow cytometry in the evaluation of post-transplant lymphoproliferative disease (PTLD) in an at-risk pediatric population and to propose flow cytometry is the most effective means of diagnosis and directed treatment.

The authors conducted a retrospective chart review of all pediatric transplant patients referred for adenotonsillectomy at a tertiary care center between May 2000 and May 2003. Thirteen patients were identified. All tonsils were evaluated for follicular lymphoid hyperplasia and atypical lymphoid cells. Seven of thirteen samples were stained for EBV RNA, and twelve of thirteen samples were tested using flow cytometry. Positive flow cytometry diagnosis was based on the presence of atypical lymphocytes, gene arrangement, or both.

Seven of thirteen (7/13) examined patients were found to have adenotonsillar hypertrophy. Ten of thirteen (10/13) patients had elevated EBV serum titers. Four of thirteen (4/13) patients were found PTLD positive by flow cytometry. Of the four positive patients, all four patients were found to have elevated EBV titers and only two patients had adenotonsillar hypertrophy.

Adenotonsillar hypertrophy is not a sensitive indicator of PTLD. EBV serum titers are sensitive but nonspecific. Flow cytometry is the most effective diagnostic modality and allows physicians to tailor treatment to specific forms of PTLD.