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Epstein-Barr virus seronegativity at the time of organ transplantation is a known risk factor for PTLD, with associated risk of developing EBV-related lymphoid hyperplasia. Our results indicate a higher incidence of symptoms and signs consistent with adenotonsillar hypertrophy in the EBV seronegative population. Adenotonsillar hypertrophy may be a precursor to EBV-related lymphoid hyperplasia and PTLD and must be identified in this patient population.

To compare lymphocyte immunohistochemical markers and staining for Epstein-Barr virus (EBV) in tonsillectomy specimens from healthy children and pediatric transplant recipients.Design: Analysis of pathology specimens.Setting: Tertiary care medical center.Patients: Consecutive sample of tonsillectomy specimens from 60 pediatric solid organ transplant recipients and 60 healthy children.Intervention: Immunohistochemical staining of tonsillectomy specimens for and light chains, B and T lymphocytes, EBV-encoded small nuclear RNA (EBV-EBER), and EBV-encoded latent membrane protein (EBV-LMP).Main Outcome Measure: Detection of a difference in EBV activity in transplant recipients vs healthy controls.Results: There was 1 case of posttransplantation lympho-proliferative disorder (PTLD). All other tonsillectomy specimens from both groups demonstrated follicular hyperplasia. Tonsillectomy specimens from both groups were polyclonal, expressing and light-chain activity, including the case of PTLD. The number of specimens staining positive for CD3 activity, a marker of T lymphocytes, was reduced in the transplant group (85%), compared with 100% in the control group (PϽ.01). EBV-EBER is a nuclear stain indicating active EBV infection, whereas EBV-LMP staining denotes latent infection. Twenty-seven of 60 transplant specimens (45%) demonstrated EBV-EBER activity compared with 0 of 60 control specimens (PϽ.001). EBV-LMP activity was equal in both groups.Conclusions: Adenotonsillar hypertrophy in transplant recipients with no prior exposure to EBV may be a sign of active EBV infection. A high incidence of EBV-EBER was found in the tonsils of transplant recipients. Active adenotonsillar EBV infection in the setting of Tlymphocyte suppression in transplant recipients may be a potential early precursor of PTLD.

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