Related Experiment Video
Updated: May 30, 2025
Expression of Exogenous Cytokine in Patient-derived Xenografts via Injection with a Cytokine-transduced Stromal Cell Line
Published on: May 10, 2017
Predictors of Posttransplant Lymphoproliferative Disease in Pediatric Patients
Brett Campbell1,2, Alexa J Kacin1,2, JoAnn Morey3
1Department of Otolaryngology-Head and Neck Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts, U.S.A.
Insights
Posttransplant lymphoproliferative disorder (PTLD) in pediatric transplant patients can mimic benign hyperplasia. Sore throat, fever, and elevated Epstein-Barr Virus (EBV) PCR are key indicators of PTLD.
Area of Science:
- Pediatric transplantation
- Immunology
- Otolaryngology
Background:
- Posttransplant lymphoproliferative disorder (PTLD) is a serious complication following pediatric solid organ transplantation.
- Distinguishing PTLD from benign adenotonsillar lymphoid hyperplasia is challenging and impacts treatment decisions.
Purpose of the Study:
- To identify predictive factors for PTLD in pediatric solid organ transplant recipients undergoing tonsillectomy or adenoidectomy.
- To aid in the clinical decision-making process regarding adenotonsillectomy in this patient population.
Main Methods:
- Retrospective analysis of electronic medical records from 2000-2023 at a quaternary children's hospital.
- Inclusion of solid organ transplant patients who underwent tonsillectomy and/or adenoidectomy.
- Analysis of demographics, clinical presentation, and Epstein-Barr Virus (EBV) serologies to identify PTLD predictors.
Main Results:
- Of 114 patients, 28.1% were diagnosed with PTLD.
- Factors like age, sex, race, and organ type were not associated with PTLD.
- Patients with PTLD were more likely to present with smaller tonsils, sore throat, fever, and tonsillar exudate, and less likely to have sleep-disordered breathing.
- Increased Epstein-Barr Virus (EBV) PCR copy number strongly correlated with PTLD risk (p < 0.003).
Conclusions:
- Tonsillar hypertrophy and sleep-disordered breathing are not definitive signs of PTLD.
- Clinical suspicion for adenotonsillar PTLD should integrate symptomatology, physical examination, EBV serologies, and EBV PCR levels.
- Sore throat, fever, tonsillar exudates, and significantly elevated EBV PCR are critical indicators for PTLD.
Objective:
Posttransplant lymphoproliferative disorder (PTLD) is a complication of pediatric solid organ transplantation. Benign adenotonsillar lymphoid hyperplasia confounds the ability to diagnose PTLD. Our aim was to identify factors that predict the presence of PTLD to inform decision-making regarding adenotonsillectomy.
Methods:
The electronic medical records at a quaternary children's hospital were queried over a 23-year period (2000-2023) for solid organ transplant patients that underwent tonsillectomy and/or adenoidectomy. Demographics, clinical presentation, and EBV serologies were analyzed to determine factors associated with presence of PTLD on final pathology.
Results:
A total of 114 patients met inclusion criteria for analysis. Thirty-two of the 114 patients (28.1%) who underwent tonsillectomy and/or adenoidectomy had PTLD. Age at transplant, age at biopsy, sex, race, and type of organ transplanted were not found to be associated with development of PTLD. Patients with PTLD were more likely to have smaller tonsils, sore throat, fever, and tonsillar exudate; they were less likely to experience sleep disordered breathing. The immunosuppression agent used for induction and the number of maintenance immunosuppressive medications were not associated with the development of PTLD. Increased Epstein-Barr Virus (EBV) PCR copy number correlated to increased risk of developing PTLD (p < 0.003).
Conclusion:
Tonsillar hypertrophy and sleep disordered breathing are not necessarily indicative of the presence of PTLD. Suspicion for adenotonsillar PTLD should be based on symptomatology, clinical exam, EBV serologies, and degree of EBV PCR positivity. Sore throat, fever, tonsillar exudates, and significant elevation in EBV PCR copy number are particularly concerning for PTLD.
Level Of Evidence:
3 Laryngoscope, 135:2182-2189, 2025.
