Publication date: Available online 23 August 2018
Source: International Journal of Pediatric Otorhinolaryngology
Author(s): Jessica Roberts, Jason Powel, Michael Mather, Steven Powell, Malcolm Brodlie
Abstract
Objective
Paediatric solid organ transplantation is an increasingly successful treatment. Improved survival is paralleled by increased secondary complications of immunosuppression, including post-transplant lymphoproliferative disease (PTLD). PTLD frequently presents in Waldeyer's lymphatic ring. Adenotonsillar hypertrophy (ATH) is common in children, however in children after transplant, ATH may indicate PTLD. We review the literature on ATH and the role of adenotonsillectomy in children after transplantation.
Methods
A comprehensive literature search was performed on 26 t h September 2017 of Ovid Medline (1996 – September 2017), Embase (1996 -2017) and EBM reviews (Cochrane database of systematic reviews 2005 – September 20 t h 2017). Results were limited to English language publications within the last 20 years. Abstracts were screened for relevance to PTLD and ATH in the paediatric solid organ transplantation population. Screening of the bibliographies identified further articles.
Results
85 unique articles were screened to yield 18 relevant articles. 10 were retrospective studies and 8 were prospective studies.
Conclusion
In children, we report a PTLD incidence of up to 15% with up to 63% of cases presenting in the head and neck. Histological examination of adenotonsillectomy specimens found PTLD in a mean 5.7% (range 0 – 39%). We found a lack of prospective studies into this topic and further high quality research is needed. Clinical assessment of ATH in children after transplantation and when to perform a diagnostic adenotonsillectomy remains challenging. Children with ATH warrant prompt further investigation and support from colleagues in transplantation and oncology is required.
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