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Airway inflammation and symptoms in children following liver and heart transplantation
Author(s) -
Redmann Andrew J.,
Bucuvalas John C.,
Wood Robert E.,
Chin Clifford,
Hart Catherine K.
Publication year - 2017
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/ctr.12971
Subject(s) - medicine , immunosuppression , airway , airway obstruction , endoscopy , transplantation , biopsy , surgery , gastroenterology , liver transplantation
Objectives To describe the upper airway endoscopic findings of children with upper airway symptoms after liver transplantation ( LT ) or heart transplantation ( HT ). Methods Review of children undergoing airway endoscopy after LT or HT from 2011 to 2015 at a tertiary care pediatric hospital. Airway findings, biopsy results, immunosuppression, and Epstein‐Barr virus ( EBV ) levels were recorded. Results Twenty‐three of 158 LT (111) and HT (47) recipients underwent endoscopy. Median time from LT to endoscopy was 9 months (range 4‐25) and 31 months (range 1‐108) for HT . Thirteen of 23 patients presented with upper airway symptoms, and 10/23 presented with respiratory failure or for surveillance. Thirteen patients with upper airway symptoms had abnormal findings (7 LT ; 6 HT ), most commonly arytenoid edema (13 patients). There were five EBV ‐positive biopsies (four with post‐transplant lymphoproliferative disorder), and six EBV ‐negative biopsies with lymphocytic inflammation. One biopsy demonstrated fungal infection. Immunosuppression was decreased in seven patients, and three received steroids. There were no episodes of allograft rejection. No patients had airway symptoms at last follow‐up. Conclusions In pediatric solid organ transplant recipients, symptoms of airway obstruction are not uncommon and should be evaluated with endoscopy. Endoscopy without symptoms is low‐yield. Treatment with decreased immunosuppression improved airway symptoms.