title: Cytomegalovirus infection and development of biliary complications after liver transplantation.
abstract: BACKGROUND
  Cytomegalovirus (CMV) infection is known to cause ulceration and mucosal hemorrhage in the gastrointestinal tract. Gastroduodenal and biliary complications were prospectively evaluated in 100 consecutive liver transplant patients in whom CMV was monitored during the first posttransplant year.
  
  
  METHODS
  Gastroduodenal biopsy specimens were taken from 36 patients by endoscopies and in 28 patients by endoscopic retrograde cholangiopancreatography, and bile duct specimens were taken from three patients who underwent surgical reconstruction because of biliary complication. CMV was demonstrated from blood by the pp65 antigenemia test and from frozen sections of tissue specimens by immunohistochemistry and in situ hybridization.
  
  
  RESULTS
  Symptomatic CMV infection, treated with ganciclovir, developed in 49 recipients: 13 (100%) of CMV seropositive donor (D+) seronegative recipient (R-) cases, 29 (45%) D+/R+ cases, and 7 (32%) D-/R+ cases. Duodenal ulcer developed in three and hemorrhagic gastritis in three recipients. CMV antigens were found from the gastroduodenal mucosa in 37 (69%) of the 54 studied recipients. The biliary complication rate was 24%. Preceding or concomitant CMV antigenemia was demonstrated in 75% of patients with a biliary complication (68% in CMV D+/R+ or D-/R+ and 100% in D+/R- recipients). The biliary complication rate was higher among recipients with CMV antigenemia, compared with recipients without (P<0.05). CMV antigenemia, CMV infection, or both in the duodenal mucosa was found in 96% of patients with a biliary complication. In two patients who underwent surgical reconstruction, CMV antigens and DNA were demonstrated in the bile ducts.
  
  
  CONCLUSIONS
  Liver transplant patients are at risk of developing biliary complications after CMV infection, especially those with primary CMV infection.
authors.affiliation: Transplantation and Liver Surgery Unit, Department of Surgery, Helsinki University Hospital and Helsinki University, Helsinki, Finland. leena.halme@hus.fi.
authors.forename: Leena
authors.initials: L
authors.lastname: Halme
authors.forename: Krister
authors.initials: K
authors.lastname: Hockerstedt
authors.forename: Irmeli
authors.initials: I
authors.lastname: Lautenschlager
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001660:Biliary Tract Diseases / Q000401:mortality* / Q000473:pathology / Q000821:virology*; D002760:Cholangiopancreatography, Endoscopic Retrograde; D003586:Cytomegalovirus Infections / Q000401:mortality* / Q000473:pathology; D004381:Duodenal Ulcer / Q000401:mortality / Q000473:pathology / Q000821:virology; D005260:Female; D005756:Gastritis / Q000401:mortality / Q000473:pathology / Q000821:virology; D006085:Graft Survival; D006801:Humans; D017093:Liver Failure / Q000401:mortality / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000821:virology