Abstract
Background
Previous studies have found that pediatric solid organ transplant recipients suffer from adenotonsillar hyperplasia. However, as this condition is also common in normal children, it remains unclear whether the incidence is truly increased. The aim of this study was to compare the incidences of surgery on the adenoids and tonsils of normal children with those receiving renal transplants and to define risk factors in the transplant population.
Methods
Data on 49 consecutive children from a single renal transplant unit were compared to data from a large governmental survey of healthy German children (KiGGS). For analysis of ‘survival without operation’, controls were matched for gender, region and immigration status (n = 8,650), as well as for age to compare incidence rates (n = 637).
Results
The age-matched solid organ transplant recipients had a higher incidence of adenoidectomies [2.3-fold, [95 % confidence interval (CI) for relative risk 1.6–3.3) and a higher incidence of tonsillectomies/tonsillotomies (3.5-fold, 95 % CI 2.1–5.7). The normal peak of adenoidectomies was delayed by 2 years in the pre-school group, and transplanted teenagers showed an extra peak for both operations. Boys and those transplanted at a younger age were significantly more likely to need adenoidectomies. Ciclosporin levels, Epstein–Barr virus and cytomegalovirus infections did not influence the incidence of operations.
Conclusion
Children receiving renal transplants are at markedly increased risk of adenotonsillar hyperplasia requiring surgery, especially males and young recipients.
Similar content being viewed by others
Notes
5 EBV positive children had already undergone complete removal of their tonsils before transplantation and are therefore not included in the calculation of risk for tonsillectomy after transplantation.
References
Kamtsiuris P, Bergmann E, Rattay P, Schlaud M (2007) Use of medical services. Results of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS). Bundesgesundheitsbl Gesundheitsforsch Gesundheitsschutz 50:836–850
Darrow DH, Siemens C (2002) Indications for tonsillectomy and adenoidectomy. Laryngoscope 112:6–10
Baldassari CM, Mitchell RB, Schubert C, Rudnick EF (2008) Pediatric obstructive sleep apnea and quality of life: a meta-analysis. Otolaryngol Head Neck Surg 138:265–273
Huang RY, Shapiro NL (2000) Adenotonsillar enlargement in pediatric patients following solid organ transplantation. Arch Otolaryngol Head Neck Surg 126:159–164
Shapiro NL, Strocker AM (2001) Adenotonsillar hypertrophy and Epstein–Barr virus in pediatric organ transplant recipients. Laryngoscope 111:997–1001
Chiang S, Vu MC, Nguyen M, Strocker A, Horvath S, Shapiro N (2002) Adenotonsillar enlargement in pediatric organ transplant recipients: a cross-sectional analysis. Otolaryngol Head Neck Surg 127:109–114
Ellis D, Jaffe R, Green M, Janosky JJ, Lombardozzi-Lane S, Shapiro R, Scantlebury V, Vivas C, Jordan ML (1999) Epstein–Barr virus-related disorders in children undergoing renal transplantation with tacrolimus-based immunosuppression. Transplantation 68:997–1003
Lattyak BV, Rosenthal P, Mudge C, Roberts JP, Renze JF, Osorio RW, Emond JC, Lalwani AK (1998) Posttransplant lymphoproliferative disorder presenting in the head and neck. Laryngoscope 108:1195–1198
Shapiro R, Nalesnik M, McCauley J, Fedorek S, Jordan ML, Scantlebury VP, Jain A, Vivas C, Ellis D, Lombardozzi-Lane S, Randhawa P, Johnston J, Hakala TR, Simmons RL, Fung JJ, Starzl TE (1999) Posttransplant lymphoproliferative disorders in adult and pediatric renal transplant patients receiving tacrolimus-based immunosuppression. Transplantation 68:1851–1854
McDonald RA, Smith JM, Ho M, Lindblad R, Ikle D, Grimm P, Wyatt R, Arar M, Liereman D, Bridges N, Harmon W (2008) Incidence of PTLD in pediatric renal transplant recipients receiving basiliximab, calcineurin inhibitor, sirolimus and steroids. Am J Transplant 8:984–989
Dharnidharka VR, Sullivan EK, Stablein DM, Tejani AH, Harmon WE (2001) Risk factors for posttransplant lymphoproliferative disorder (PTLD) in pediatric kidney transplantation: a report of the North American Pediatric Renal Transplant Cooperative Study (NAPRTCS). Transplantation 71:1065–1068
Gupta S, Fricker FJ, González-Peralta RP, Slayton WB, Schuler PM, Dharnidharka VR (2010) Post-transplant lymphoproliferative disorder in children: recent outcomes and response to dual rituximab/low-dose chemotherapy combination. Pediatr Transplant 14:896–902
Dharnidharka VR, Ho P-L, Stablein DM, Harmon WE, Tejani AH (2002) Mycophenolate, tacrolimus and post-transplant lymphoproliferative disorder: a report of the North American Pediatric Renal Transplant Cooperative Study. Pediatr Transplant 6:396–399
Shapiro NL, Strocker AM, Bhattacharyya N (2003) Risk factors for adenotonsillar hypertrophy in children following solid organ transplantation. Int J Pediatr Otorhinolaryngol 67:151–155
Roy S, Vivero RJ, Smith LP (2008) Adenotonsillar pathology in post-transplant patients. Int J Pediatr Otorhinolaryngol 72:865–868
Williamson RA, Huang RY, Shapiro NL (2001) Adenotonsillar histopathology after organ transplantation. Otolaryngol Head Neck Surg 125:231–240
Köpf S, Tönshoff B (2004) Adenotonsillar hypertrophy and post-transplant lymphoproliferative disorder in pediatric renal transplant recipients. Pediatr Nephrol 19:471–472
Schwartz GJ, Brion LP, Spitzer A (1987) The use of plasma creatinine concentration for estimating glomerular filtration rate in infants, children, and adolescents. Pediatr Clin North Am 34:571–590
Strocker AM, Carrer A, Shapiro NL (2005) The validity of the OSA-18 among three groups of pediatric patients. Int J Pediatr Otorhinolaryngol 69:241–247
Jain A, Nalesnik M, Reyes J, Pokharna R, Mazariegos G, Green M, Eghtesad B, Marsh W, Cacciarelli T, Fontes P, Abu-Elmagd K, Sindhi R, Demetris J, Fung J (2002) Posttransplant lymphoproliferative disorders in liver transplantation: a 20-year experience. Ann Surg 236:429–436, discussion 436–437
Motta G, Casolino D, Cassiano B, Conticello S, Esposito E, Galletti F, Galli V, Larotonda G, Laudadio P, Mansi N, Mevio E, Mira E, Motta G Jr, Ceroni AR, Tarantino V, Tavormina P, Vicini C, Motta S, Aversa S, Canani FB, Cappello V, Carra P, Cifarelli D, Cinquegrana G, Consolo E, Ondolo C, Ripa G, Romano G (2008) Adeno-tonsillar surgery in Italy. Acta Otorhinolaryngol Ital 28:1–6
Lesinskas E, Drigotas M (2009) The incidence of adenoidal regrowth after adenoidectomy and its effect on persistent nasal symptoms. Eur Arch Otorhinolaryngol 266:469–473
Eviatar E, Kessler A, Shlamkovitch N, Vaiman M, Zilber D, Gavriel H (2009) Tonsillectomy vs. partial tonsillectomy for OSAS in children–10 years post-surgery follow-up. Int J Pediatr Otorhinolaryngol 73:637–640
Vestergaard H, Wohlfahrt J, Westergaard T, Pipper C, Rasmussen N, Melbye M (2007) Incidence of tonsillectomy in Denmark, 1980 to 2001. Pediatr Infect Dis J 26:1117–1121
Mattila PS, Tahkokallio O, Tarkkanen J, Pitkäniemi J, Karvonen M, Tuomilehto J (2001) Causes of tonsillar disease and frequency of tonsillectomy operations. Arch Otolaryngol Head Neck Surg 127:37–44
Piacentini GL, Peroni DG, Blasi F, Pescollderungg L, Goller P, Gallmetzer L, Drago L, Bodini A, Boner AL (2010) Atypical bacteria in adenoids and tonsils of children requiring adenotonsillectomy. Acta Otolaryngol 130:620–625
Their M, Holmberg C, Lautenschlager I, Höckerstedt K, Jalanko H (2000) Infections in pediatric kidney and liver transplant patients after perioperative hospitalization. Transplantation 69:1617–1623
Endo LH, Ferreira D, Montenegro MC, Pinto GA, Altemani A, Bortoleto AE, Vassallo J (2001) Detection of Epstein-Barr virus in tonsillar tissue of children and the relationship with recurrent tonsillitis. Int J Pediatr Otorhinolaryngol 58:9–15
Snow AL, Martinez OM (2007) Epstein-Barr virus: evasive maneuvers in the development of PTLD. Am J Transplant 7:271–277
Mowry SE, Strocker AM, Chan J, Takehana C, Kalantar N, Bhuta S, Shapiro NL (2008) Immunohistochemical analysis and Epstein-Barr virus in the tonsils of transplant recipients and healthy controls. Arch Otolaryngol Head Neck Surg 134:936–939
Shapiro NL, Tang CG-Z, Bhattacharyya N (2011) Association between Epstein-Barr virus seroconversion and immunohistochemical changes in tonsils of pediatric solid organ transplant recipients. Laryngoscope 121:1718–1725
Barozzi P, Potenza L, Riva G, Vallerini D, Quadrelli C, Bosco R, Forghieri F, Torelli G, Luppi M (2007) B cells and herpesviruses: a model of lymphoproliferation. Autoimmun Rev 7:132–136
Monroy A, Behar P, Brodsky L (2008) Revision adenoidectomy–a retrospective study. Int J Pediatr Otorhinolaryngol 72:565–570
Dearking AC, Lahr BD, Kuchena A, Orvidas LJ (2012) Factors associated with revision adenoidectomy. Otolaryngol Head Neck Surg 146:984–990
Vaziri ND, Pahl MV, Crum A, Norris K (2012) Effect of uremia on structure and function of immune system. J Ren Nutr 22:149–156
Betjes MGH (2013) Immune cell dysfunction and inflammation in end-stage renal disease. Nat Rev Nephrol 9:255–265
Bouts AHM, Davin JC, Krediet RT, Monnens LAH, Nauta J, Schröder CH, van Lier RAW, Out TA (2004) Children with chronic renal failure have reduced numbers of memory B cells. Clin Exp Immunol 137:589–594
Acknowledgments
The authors thank the Robert Koch Institute for the provision of data on healthy children from the KiGGS Study [1].
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Gimpel, C., Heinrich, A., Fehrenbach, H. et al. Increased incidence of adenoidectomy and tonsillectomy in children with renal transplantation. Pediatr Nephrol 29, 1441–1450 (2014). https://doi.org/10.1007/s00467-014-2775-x
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00467-014-2775-x