Eosinophilic Esophagitis in a Large Cohort of Pediatric Liver Transplant Recipients

The prevalence of eosinophilic esophagitis (EoE) is up to 100 times greater in the liver transplant (LT) population than the general population. The purpose of this study was to identify differences between children who underwent LT and developed EoE and those who did not develop EoE. Identifying differences may permit earlier detection and treatment of EoE in this population.

We performed a retrospective, cross-sectional single-center study of children who underwent LT between 2007 and 2021 to identify patients who developed EoE compared to those who did not develop EoE following LT.

In this study, the prevalence of EoE in patients post LT is 8% and 13% in those undergoing esophagogastroduodenoscopy (EGD) for gastrointestinal (GI) symptoms post LT. Of 159 patients who underwent LT, 25% (n = 40) had GI symptoms necessitating EGD. Of these, 33% (n = 13) were diagnosed with EoE (EoE-LT) and 67% (n = 27) did not have EoE (non-EoE-LT). EoE-LT patients had a longer time from transplant to their first EGD compared to non-EoE-LT (2.93 vs. 0.90 years, p = 0.007). EoE-LT patients were more likely to have other allergic disorders (77% vs. 30%, p = 0.01), peripheral eosinophilia (62% vs. 11%, p = 0.003), or more feeding difficulties (62% vs. 11%, p = 0.003) than non-EoE-LT. Non-EoE-LT patients were more likely to undergo esophagogastroduodenoscopy (EGD) for gastrointestinal bleeding than EoE-LT (30% vs. 0%, p = 0.04). Among the EoE-LT patients who underwent follow-up EGD (n = 10), half were in histologic remission.

The presence of feeding difficulties, allergic disorders, or peripheral eosinophilia in children who have undergone LT should raise suspicion for EoE.