Prevalence of cytomegalovirus in the gastrointestinal tract of renal transplant recipients with persistent abdominal pain.
Abdominal pain occurs frequently in renal transplant recipients receiving mycophenolate mofetil (MMF) therapy. The cause of this abdominal pain has not been fully elucidated, but may involve local irritation, as well as inhibition of rapidly dividing cells of the gastrointestinal (GI) tract. This milieu of inflammation and added immunosuppression is conducive to activation of cytomegalovirus (CMV). We therefore sought to find the prevalence of active CMV in patients presenting with abdominal pain on maintenance MMF therapy. All patients receiving a renal transplant at our center from March 1, 1997, to September 1, 1997, were studied. Any patient presenting with midepigastric pain for greater than 3 days underwent esophagogastroduodenoscopy (EGD) with biopsy. CMV was diagnosed by the presence of inclusion bodies and immunohistochemical studies. Ten patients presented with persistent midepigastric pain; nine of these patients had evidence of GI CMV. Patients who were CMV negative and received an allograft from CMV-positive donors and those with leukopenia were at significantly increased risk for the development of abdominal pain. In our study population, the majority of patients on maintenance MMF therapy who presented with persistent midepigastric pain had evidence of active CMV infection in the upper gastrointestinal tract.
Department of Transplantation, Saint Barnabas Medical Center, Livingston, NJ, USA.
B
B
Kaplan
H U
HU
Meier-Kriesche
M G
MG
Jacobs
G
G
Friedman
L
L
Bonomini
P
P
DeFranco
E
E
Gelfand
S
S
Mulgaonkar
D015746:Abdominal Pain / Q000209:etiology*; D000328:Adult; D003586:Cytomegalovirus Infections / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology; D004064:Digestive System / Q000821:virology; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D015994:Incidence; D016030:Kidney Transplantation; D016015:Logistic Models; D008297:Male; D009173:Mycophenolic Acid / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D015995:Prevalence; D012307:Risk Factors
D007166:Immunosuppressive Agents; D009173:Mycophenolic Acid