Immunohistochemically proven cytomegalovirus end‐organ disease in solid organ transplant patients: clinical features and usefulness of conventional diagnostic tests

Abstract

We studied the main clinical features, outcome, and laboratory parameters in a group of solid organ transplant (SOT) patients with immunohistochemically proven cytomegalovirus (CMV) disease. Confirmed CMV cases were obtained through databases. Demographics, clinical data, transplantation type, immunosuppressive regimens, donor and recipient CMV serostatus, therapy, outcome and laboratory results, pp65 antigenemia, and qualitative polymerase chain reaction (PCR) for CMV were analyzed. From 1995 to 2004, 31 cases with complete medical records were identified. Disease appeared between 24 and 2538 days after transplantation but most cases presented in the first 100 days. Gastrointestinal CMV disease was the most frequent form (71%), while thrombocytopenia was present in 50% of cases, and leukopenia was less common (35.5%). CMV pp65 antigenemia was positive in 58% of patients, but its sensitivity increased to 71% if performed during the first 6 months. A qualitative CMV PCR technique gave similar results during this period (71.4%). Most patients were treated with intravenous ganciclovir (n=25; 80.6%). In 4 cases (19.4%), use of foscarnet alone or a sequential regimen with ganciclovir-foscarnet was deemed necessary. Surgical procedures were necessary in 5 patients (16%). The death rate reached 13%. CMV end-organ disease can be a life-threatening infection in SOT patients. Gastrointestinal disease was the most frequent end-organ disease. CMV antigen detection is best suited for the early period after transplantation.

Current concepts on cytomegalovirus infection after liver transplantation

“…In the current era, gastrointestinal CMV disease constitutes the vast majority of tissueinvasi ve cases [3,7,20] , and in a number of cases, especially in CMV R+ patients, this type of CMV disease is "compartmentalized." In a retrospective study, the sensitivity of pp65 antigenemia assay (defined as detection of ≥ 1 positi ve cells/2 ×10 5 leukocytes) for diagnosis of CMV gastrointestinal disease was only 54% [82] .…”

“…These have been traditionally categorized either as CMV syndrome (fever with bone marrow suppression) and tissueinvasi ve CMV disease (which may involve virtually any organ system) [6] . The most common organ system involved during CMV disease is the gastrointestinal tract (in the form of CMV gastritis, esophagitis, enteritis, and colitis), accounting for over 70% of tissueinvasi ve CMV disease cases in solid organ transplant recipients [7] . The transplanted liver also seems to be more predisposed to develop tissueinvasion by CMV such that CMV hepatitis occurs more frequently in liver transplant recipients than in other solid organ transplant recipients.…”

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“…2 Although CMV peritonitis also has been reported after solid-organ transplant, it is rare and mostly associated with gut perforation. In a series of CMV infections after solid-organ transplanted patients from Spain, 2 cases of peritonitis were reported but 6 Another series of 3 patients with CMV-associated peritonitis were reported after renal transplant, but all had sigmoid perforation documented on laparotomy. 7 There is one report of CMV peritonitis without gut perforation after renal transplant in a patient who was previously on peritoneal dialysis.…”

Assessment of Antigenemia Assay for the Diagnosis of Cytomegalovirus Gastrointestinal Diseases in HIV-Infected Patients

“…The antigenemia assay is one of the most widely used methods for detecting reactivation of CMV infection, but only a few studies have examined its diagnostic value for CMV-GID, [18][19][20][21] and all were retrospective in design. Jang et al 20 recently reported that the sensitivity and specificity of the CMV antigenemia assay for the diagnosis of CMV-GID were 54% and 88%, respectively, in patients with secondary immunodeficiency disease.…”