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  • 1 PhD School, Clinical Medicine, Semmelweis University, Budapest, Hungary
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Abstract

Gastrointestinal complications of solid organ transplant patients are frequent; they may be even life-threatening. Less serious complaints mean considerable deterioration in quality of life of patients indeed. The reasons of these complications are generally complex related to the original disease, organ transplant operation, graft function, and immunosuppression. Gastrointestinal complications of immunosuppression are the result of the side effects of immunosuppressive therapy or consequences of different infections. Cytomegalovirus is a major pathogen for transplant patients even in the gastrointestinal tract. Considerable number of transplanted patients is followed up in our clinic. The basic diagnostic method of gastrointestinal complications is endoscopy with endoscopic biopsy. In this study our experiences of upper endoscopies on symptomatic solid organ transplant patients were reviewed. Symptoms, complaints, endoscopical and histological findings of patients were analyzed. Findings on kidney and liver transplant patients were compared: gastric ulcers, Helicobacter pylori and candida infections were more frequent on kidney transplanted patients. Conventional histology proved less suitable for the diagnosis of cytomegalovirus infection from biopsy samples, qualitative polymerase chain reaction method was used for detection of viral DNA. With this method in 48 % of investigated transplant patients CMV infection was proved; in about half of these patients gastrointestinal CMV disease was supposed. Criteria of antiviral treatment were determined. The proportion of urgent endoscopies for upper gastrointestinal bleeding proved significantly higher in liver transplant patients, the most frequent source of bleeding were esophageal varices. However, in kidney transplant patients bleeding gastro-duodenal ulcers were found more frequently. Diagnostic and therapeutic urgent upper endoscopies on organ transplant patients are suggested to perform by the same way as by endoscopies on non-transplanted patients. Further investigations could be performed to analyze the immunosuppressive drug induced mucosal lesions, and to evaluate the detection of CMV replication in the gastrointestinal tract.

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