View More View Less
  • 1 Department of Transplantation Surgery, Semmelweis University Medical School, Budapest, Hungary
  • | 2 Baross utca 23, H-1082, Budapest, Hungary
Restricted access

Cross Mark

Abstract

Cytomegalovirus (CMV) is a major pathogen for immunocompromised organ transplant recipients. 80 to 90% of all transplant recipients are infected by the virus; however, the incidence of CMV disease is 30 to 40%. Gastrointestinal CMV disease involving any part of the digestive tract occurs in about 10% of all patients receiving solid organ transplantation. Mucosal injury, ulcerations, erosions, haemorrhage, disorders of digestive tract motility, rarely gastrointestinal mass and perforation are the most common pathological findings in CMV disease. Diagnostics is based on endoscopy with mucosal biopsy. Histopathological examination of biopsy samples must look for specific cytomegalic cells with intranuclear (“owl's eye”) and intracytoplasmatic inclusions. Various microbiological, immunohistochemical and molecular biological assays can be performed to detect CMV in the mucosa. In established gastrointestinal CMV disease both gastroenterological and antiviral treatments are needed including intravenous ganciclovir and/or oral valganciclovir. Prevention of disease should be achieved by general prophylaxis in high-risk patients (oral valganciclovir, in special cases hyperimmune globulin); and in medium risk patients by pre-emptive therapy using microbiological surveillance.

  • [1]. R. Patel C. V. Paya 1997 Infections in solid-organ transplant recipients Clin.Microbiol. Rev. 10 86124.

  • [2]. S. Sarkio L. Halme L. Kyllönen et al. 2004 Severe gastrointestinal complications after 1515 adult kidney transplantations Transplant. Int. 17 505510.

    • Search Google Scholar
    • Export Citation
  • [3]. R. H. Rubin 2007 The pathogenesis and clinical management of cytomegalovirus infection in the organ transplant recipients: The end of the 'silo hypothesis’ Curr. Opin. Infect. Dis. 20 399407.

    • Search Google Scholar
    • Export Citation
  • [4]. J. A. Fishman V. Emery R. Freeman et al. 2007 Cytomegalovirus in transplantation — challenging the status quo Clin. Transplant. 21 149159.

    • Search Google Scholar
    • Export Citation
  • [5]. S. Norris Y. Kosar N. Donaldson et al. 2002 Cytomegalovirus infection after liver transplantation: Viral load as a guide to treating clinical infection Transplantation 74 527531.

    • Search Google Scholar
    • Export Citation
  • [6]. A. Humar M. Michaels 2006 American Society of Transplantation Recommendations for screening, monitoring and reporting of infectious complications in immunosuppression trials on recipients of organ transplantation Am. J. Transplant. 6 262274.

    • Search Google Scholar
    • Export Citation
  • [7]. R. W. Goodgame 1993 Gastrointestinal cytomegalovirus disease Ann. Intern. Med. 119 924935.

  • [8]. I. G. Sia R. Patel 2000 New strategies for prevention and therapy of cytomegalovirus infection and disease in solid-organ transplant recipients Clin.Microbiol. Rev. 13 83121.

    • Search Google Scholar
    • Export Citation
  • [9]. A. Gautam 2006 Gastrointestinal complications following transplantation Surg. Clin. N. Am. 86 11951206.

  • [10]. J. H. Helderman S. Goral 2002 Gastrointestinal complications of transplant immunosuppression J. Am. Soc. Nephrol. 13 277287.

  • [11]. I. R. Lai K. M. Chen C. T. Shun et al. 1996 Cytomegalovirus enteritis causing massive bleeding in patients with AIDS Hepato-Gastroenterology 43 987991.

    • Search Google Scholar
    • Export Citation
  • [12]. E. F. Maar J. H. Kleibeuker W. Boersma-van Ek et al. 1996 Increased intestinal permeability during cytomegalovirus infection in renal transplant recipients Transpl. Int. 9 576580.

    • Search Google Scholar
    • Export Citation
  • [13]. K. Omori K. Hasegawa M. Ogawa et al. 2002 Small-bowel hemorrhage caused by cytomegalovirus vasculitis following fulminant hepatitis J. Gastroenterol. 37 954960.

    • Search Google Scholar
    • Export Citation
  • [14]. C. Ponticelli P. Passerini 2005 Gastrointestinal complications in renal transplant recipients Transpl. Int. 18 643650.

  • [15]. R. H. Rubin 2001 Gastrointestinal infectious disease complications following transplantation and their differentiation from immunosuppressant-induced gastrointestinal toxicities Clin. Transplant. 15 1122.

    • Search Google Scholar
    • Export Citation
  • [16]. B. M. Shestha D. Parton A. Gray et al. 1996 Cytomegalovirus involving gastrointestinal tract in renal transplant recipients Clin. Transplant. 10 170175.

    • Search Google Scholar
    • Export Citation
  • [17]. R. N. Murray A. Parker S. C. Kadia et al. 1994 Cytomegalovirus in upper gastrointestinal ulcers J. Clin. Gastroenterol. 19 198201.

  • [18]. A. Péter G. Telkes M. Varga et al. 2004 Endoscopic diagnosis of cytomegalovirus infection of upper gastrointestinal tract in solid organ transplant recipients: Hungarian single-center experience Clin. Transplant. 18 580584.

    • Search Google Scholar
    • Export Citation
  • [19]. I. Aleksic M.M. Bayalei B. Schorn et al. 1998 Resection for CMV ileitis in a patient supported by a left-ventricular assist device Thorac. Cardiovasc. Surg. 46 105106.

    • Search Google Scholar
    • Export Citation
  • [20]. G. J. Toogood P. H. Gillespie S. Gujral et al. 1996 Cytomegalovirus infection and colonic perforation in renal transplant patients Transpl. Int. 9 248251.

    • Search Google Scholar
    • Export Citation
  • [21]. R. W. Goodgame R. M. Genta R. Estrada et al. 1993 Frequency of positive tests for cytomegalovirus in AIDS patients: Endoscopic lesions compared with normal mucosa Am. J. Gastroenterol. 88 338343.

    • Search Google Scholar
    • Export Citation
  • [22]. S. Sarkio L. Halme J. Arola et al. 2005 Gastroduodenal cytomegalovirus infection is common in kidney transplantion patients Scand. J. Gastroenterol. 40 508514.

    • Search Google Scholar
    • Export Citation
  • [23]. O. S. Slusser J. P. Boehmer J. Zurlo et al. 1995 Questioning the clinical significance of upper gastrointestinal cytomegalovirus disease following heart transplantation Dig. Dis. Sci. 40 18241830.

    • Search Google Scholar
    • Export Citation
  • [24]. H. A. Torres D. P. Kontoyiannis G. P. Bodey et al. 2005 Gastrointestinal cytomegalovirus disease in patients with cancer: A two decade experience in a tertiary care center Eur. J. Cancer 41 22682279.

    • Search Google Scholar
    • Export Citation
  • [25]. V. C. Emery 2001 Investigation of CMV disease in immunocompromised patients J. Clin. Pathol. 54 8488.

  • [26]. F. Pereyra R. H. Rubin 2004 Prevention and treatment of cytomegalovirus infection in solid organ transplant recipients Curr. Opin. Infect. Dis. 17 356361.

    • Search Google Scholar
    • Export Citation
  • [27]. M. Varga Remport K. Czebe et al. 2008 Risk factors, effects of the cytomegalovirus infection and the opportunities of prevention after transplantation Orv. Hetil. 149 551558.

    • Search Google Scholar
    • Export Citation
  • [28]. C. V. Paya 2001 Prevention of cytomegalovirus disease in recipients of solid-organ transplants Clin. Infect. Dis. 32 596603.

  • [29]. M. Varga Remport M. Hidvégi et al. 2005 Comparing cytomegalovirus prophylaxis in renal transplantation: single center experience Transpl. Infect. Dis. 7 6367.

    • Search Google Scholar
    • Export Citation
  • [30]. Y. Kanda S. Mineishi T. Saito et al. 2002 Response-oriented preemptive therapy against cytomegalovirus disease with low-dose ganciclovir: A prospective evaluation Transplantation 73 568572.

    • Search Google Scholar
    • Export Citation
All Time Past Year Past 30 Days
Abstract Views 2 2 1
Full Text Views 12 4 0
PDF Downloads 6 1 0