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Tonsillectomy Outcomes in Children After Solid-Organ Transplantation: A 15-Year Single-Center Experience
Inbal Hazkani1,2, Natalia Hajnas1,3, Mitchell Victor1,2
1Division of Pediatric Otolaryngology-Head and Neck Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Illinois, Chicago, USA.
Insights
Post-transplant lymphoproliferative disorder (PTLD) occurred in 47.3% of pediatric solid-organ transplant recipients undergoing tonsillectomy/adenotonsillectomy. Preoperative factors did not predict PTLD, and complications were similar between PTLD and non-PTLD groups.
Area of Science:
- Pediatric solid-organ transplantation
- Immunosuppression complications
- Posttransplant lymphoproliferative disorder
Background:
- Solid-organ transplantation (SOT) is standard for pediatric end-organ failure.
- Long-term immunosuppression improves survival but increases risks like secondary malignancies and poor wound healing.
- Tonsillectomy/adenotonsillectomy (T/AT) is common in SOT recipients.
Purpose of the Study:
- To determine the incidence of posttransplant lymphoproliferative disorder (PTLD) in children after SOT undergoing T/AT.
- To analyze outcomes, complications, and PTLD rates based on pathology.
- To identify potential predictors of PTLD in this population.
Main Methods:
- Retrospective cohort study at a tertiary care children's hospital.
- Chart review of 110 pediatric SOT recipients (kidney, heart, liver) who had T/AT between 2006-2021.
- Analysis of patient demographics, transplant details, T/AT indications, and pathological findings.
Main Results:
- PTLD was diagnosed in 52 (47.3%) patients post-T/AT.
- No significant differences in age, organ type, time since transplant, or immunosuppression were found between PTLD and non-PTLD groups.
- Preoperative tonsillar size or asymmetry did not correlate with PTLD diagnosis; post-T/AT complications were similar.
Conclusions:
- The incidence of PTLD in pediatric SOT recipients undergoing T/AT is high (47.3%).
- Preoperative clinical presentation and tonsillar characteristics do not predict PTLD.
- PTLD diagnosis did not increase the risk of postoperative complications following T/AT.
Objective:
Solid-organ transplantation (SOT) has become the standard of care for children with terminal organ failure. Long-term immunosuppression has improved survival substantially but is associated with secondary malignancies and impaired wound healing. Our goal was to review the incidence, outcomes, complications, and rate of posttransplant lymphoproliferative disorder on pathologic examination following tonsillectomy/adenotonsillectomy (T/AT) in children after SOT.
Study Design:
A retrospective cohort study.
Setting:
Tertiary care children's hospital.
Methods:
Data were extracted from charts of children with a history of kidney, heart, or liver transplantation, who underwent T/AT between 2006 and 2021.
Results:
A total of 110 patients met the inclusion criteria, including 46 hearts, 41 kidneys, 19 livers, and 4 liver-and-kidney transplants. The mean age at transplantation was 4.2 years, and the mean transplantation-to-T/AT time interval was 28.8 months. The posttransplant lymphoproliferative disorder was diagnosed in 52 (47.3%) patients, and 25% of these had no tonsillar hypertrophy. There was no difference in age at transplantation, organ received, transplantation-to-T/AT time interval, immunosuppressive medications, tonsil size, or tonsillar asymmetry between patients diagnosed with the posttransplant lymphoproliferative disorder and patients with benign tonsillar/adenotonsillar hypertrophy. Posttonsillectomy complications were similar between the groups.
Conclusion:
The incidence of posttransplant lymphoproliferative disorder undergoing tonsillectomy for any indication was 47.3%. There was no association between preoperative signs and symptoms and the histopathological diagnosis of posttransplant lymphoproliferative disorder. Stratification by organ received and immunosuppressive medications did not identify differences among the groups relative to the incidence of posttransplant lymphoproliferative disorder and other postoperative complications.
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