The timing, location and histologic characterization of upper gastrointestinal cytomegalovirus infection occurring in a liver transplant population

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Abstract

Objective:

To determine the prevalence, site, best method for detection and the clinical symptoms associated with cytomegalovirus (CMV) infection of the upper gastrointestinal tract before and after liver transplantation.

Design:

Consecutive patients were endoscoped and biopsied before (n = 88) and after (n = 66) liver transplantation. Biopsies obtained from the duodenum, gastric antrum, and esophagus were assessed by culture, histopathology using specific immunohistochemical methods for CMV detection and early antigen detection using the shell vial assay technique.

Setting:

Large liver transplant center at a university hospital known for its tertiary care.

Patients:

The study included 154 consecutive patients seen by the transplant medicine service before and/or after liver transplantation.

Results:

Cytomegalovirus infection of the upper gastrointestinal tract was found in 2.2% of pre- and 32% of post-transplant patients (P < 0.001). The most frequently positive site was the gastric antrum followed by the duodenum and the esophagus. Most positive patients were seen in the second month after transplant (77%), with only 9% of patients seen in either prior to or after the second post-transplant month. The best method for CMV detection was the shell assay for early antigen; the least valuable was histopathology. The symptoms associated with CMV gastroenteritis are nonspecific and are suggestive of gastric dysmotility.

Conclusions:

Cytomegalovirus gastroenteritis is unusual before tranplantation but occurs in one-third of post-liver transplant patients. The gastrointestinal site most often involved is the gastric antrum followed by the duodenum. Most CMV infections of the upper gastrointestinal tract occur in the second month after transplant and are associated with signs and symptoms of gastric dysmotility.

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