Shapiro Nina L, Strocker Ali M, Bhattacharyya Neil
Division of Head and Neck Surgery, UCLA School of Medicine, 62-158 CHS, 10833 LeConte Avenue, Los Angeles, CA 90095, USA.
Int J Pediatr Otorhinolaryngol. 2003 Feb;67(2):151-5. doi: 10.1016/s0165-5876(02)00356-7.
Post-transplantation lymphoproliferative disorder (PTLD), or its precursor, Epstein-Barr virus (EBV)-related lymphoid hyperplasia, may first present in the tonsils and adenoids in the pediatric solid organ transplant population. We sought to identify signs and symptoms of and risk factors for adenotonsillar hypertrophy (ATH), a potential precursor to PTLD in children following solid organ transplantation.
We performed a cross-sectional study of 132 consecutive pediatric solid organ transplant patients at our institution. Questionnaire, physical examination, and laboratory data collection were obtained. Correlation of signs and symptoms of ATH with objective laboratory data was conducted.
132 pediatric transplant recipients (64 renal, 68 liver) were enrolled. Mean age at transplantation was 7.4 (S.D. 6.0) years with a mean follow-up of 49.0 (S.D. 48.4) months post-transplantation. The mean questionnaire score was 8.4 (S.D. 7.9) out of a maximum 65 and the mean physical examination score was 3.9 (S.D. 1.9) out of a maximum 8, with a statistically significant correlation between the two (Pearson's r=0.352, P<0.001). A multivariate linear regression model found recipient EBV seronegativity and younger age at transplantation to be statistically significant risk factors for development of ATH (P=0.024 and 0.035, respectively).
Young age and EBV seronegativity confer increased risk for ATH in pediatric patients undergoing solid organ transplantation. As ATH may be the earliest sign of PTLD, long-term surveillance is required to determine the impact of ATH on quality of life and survival in these patients.
移植后淋巴组织增生性疾病（PTLD）或其前驱病变，即爱泼斯坦-巴尔病毒（EBV）相关淋巴样增生，可能首先出现在小儿实体器官移植人群的扁桃体和腺样体中。我们试图确定小儿实体器官移植后，作为PTLD潜在前驱病变的腺样体扁桃体肥大（ATH）的体征、症状及危险因素。
我们对本机构132例连续的小儿实体器官移植患者进行了一项横断面研究。获取了问卷、体格检查及实验室数据。对ATH的体征和症状与客观实验室数据进行了相关性分析。
纳入了132例小儿移植受者（64例肾移植，68例肝移植）。移植时的平均年龄为7.4（标准差6.0）岁，移植后平均随访49.0（标准差48.4）个月。问卷平均得分为8.4（标准差7.9）（满分65分），体格检查平均得分为3.9（标准差1.9）（满分8分），两者之间存在统计学显著相关性（Pearson相关系数r = 0.352，P < 0.001）。多因素线性回归模型发现，受者EBV血清学阴性及移植时年龄较小是发生ATH的统计学显著危险因素（P分别为0.024和0.035）。
年龄较小和EBV血清学阴性会增加小儿实体器官移植患者发生ATH的风险。由于ATH可能是PTLD的最早体征，因此需要进行长期监测，以确定ATH对这些患者生活质量和生存的影响。
