Objectives: To describe the upper airway endoscopic findings of patients with stridor, stertor or sleep-disordered breathing after liver transplantation (LT) or heart transplantation (HT).

Methods: Retrospective review of children undergoing airway evaluation after LT or HT from 2011 to 2015 at a tertiary care pediatric hospital. Airway findings, biopsy results, immunosuppressive agents and systemic Ebstein Barr virus (EBV) PCR levels were recorded.

Results: Twenty-three of 158 LT (111) or HT (47) recipients underwent airway evaluation due to airway symptoms or respiratory failure. Nine of 23 patients presented with stridor, stertor or sleep-disordered breathing. All patients were on tacrolimus and 7 had detectable EBV levels at the time of airway evaluation. Median time from LT to airway evaluation was 9 months (range 4-25) and 31 months (range 1-108) for HT. Thirteen (57%) patients had abnormal findings (7 LT; 5 HT). The most common abnormalities were epiglottic edema/thickening (75%) and arytenoid edema/thickening (100%). Of the 5 patients who underwent laryngeal biopsies, 2 were positive for EBV, of which one had histology consistent with post-transplant lymphoproliferative disorder (PTLD). The remaining 3 showed lymphocytic inflammation. One patient had laryngeal candidiasis. Immunosuppression agents were decreased in 7 of 13 patients. Three patients received corticosteroids and 3 had no change in treatment. There were no episodes of organ rejection at last follow up. No patients had airway symptoms at last follow up, which ranged from 26-1166 days after original airway evaluation.

Conclusions: Abnormal laryngeal findings are common in LT and HT recipients who undergo airway evaluation, with arytenoid and epiglottic edema/thickening most commonly seen. While these findings may be seen in PTLD, these findings in EBV-negative, PTLD-negative patients are a new observation not previously reported in the literature. These findings suggest a non-viral etiology of airway inflammation in transplant patients. Further research is needed to better define the extent and etiology of airway inflammation following pediatric liver and heart transplantation.

CITATION INFORMATION: Redmann A, Bucuvalas J, Wood R, Chin C, Hart C. Airway Inflammation and Symptoms in Children Following Liver and Heart Transplantation. Am J Transplant. 2016;16 (suppl 3).

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