Posttransplantation Lymphoproliferative Disorder in Patients Under Primary Tacrolimus (FK 506) Immunosuppression

Post-transplant lymphoproliferative disease of the larynx

“…Redmann et al reported that 13 of 158 patients with PTLD after either liver transplant or heart transplant presented with stridor, stertor, or sleep-disordered breathing, all had abnormal supraglottic findings [7]. Consistent with the presentation of both patients in this series, multiple other case studies associate the presentation of stridor or dyspnea with laryngeal involvement [6, 8–10].…”

“…Airway visualization also contributes to the decision to secure the airway. Although neither of our patients required tracheostomy, the need, related to mass effect or difficulty with extubation, has been reported [6, 7]. We recommend follow-up laryngoscopy with biopsy to confirm disease resolution before further altering the immunosuppressive regiment.…”

“…PTLD occurs due to unchecked proliferation of lymphoid and/or plasmacytic cells in the setting of immunosuppression. Hypertrophy of Waldeyer’s ring, which may lead to upper airway obstruction, has been reported in 83% of patients with PTLD [6]. Less commonly, laryngeal infiltration leads to upper airway symptoms, such as stridor and dyspnea.…”

Late airway complications following pediatric liver transplantation: A case series

“…Although neither of our patients required tracheostomy, there was concern of mass effect challenging safe extubation, as seen in other reported cases 34,35 . Notably, airway pathology was refractory to surgical ablation in both cases.…”

“…33 Although neither of our patients required tracheostomy, there was concern of mass effect challenging safe extubation, as seen in other reported cases. 34,35 Notably, airway pathology was refractory to surgical ablation in both cases. Expedient diagnosis and alteration of immunosuppression was key to regression of airway lesions and avoidance of tracheostomy.…”