CMV findings in the gastrointestinal tract in kidney transplantation patients, patients with end-stage kidney disease and immunocompetent patients.
OBJECTIVE
Cytomegalovirus (CMV) is the most common viral pathogen affecting organ transplant recipients. The objective was to determine to what extent CMV can be found in the gastrointestinal tract in kidney transplant recipients and to compare them with patients in dialysis and randomly chosen otherwise healthy patients who were referred for oesophagogastroduodenoscopy (OEGD) or colonoscopy.


METHODS
Biopsies for CMV examinations were obtained from 130 oesophagogastroduodenoscopies and 54 colonoscopies performed on 82 kidney transplant recipients, 49 dialysis patients with chronic end-stage kidney disease and 53 immunocompetent patients because of clinical indications. CMV was demonstrated by immunohistochemistry, both in frozen sections using a monoclonal antibody against CMV-specific antigens (pp65 matrix protein) and in paraffin sections by means of a monoclonal antibody against the delayed early protein (p52).


RESULTS
CMV-positive cells were found in the gastroduodenal mucosa in 46 (68%) out of 82 kidney transplant recipients, in 9 (31%) of 49 dialysis patients and in 15 (45%) of 53 immunocompetent patients, in the colorectal mucosa in 7 (50%), in 6 (30%) and in 9 (45%) of the patient groups, respectively. In the transplant recipient group, 4 patients had severe and 10 patients moderate CMV infection in the gastroduodenal mucosa. CMV disease was diagnosed in two patients with severe infection and in one patient with moderate infection. All dialysis and immunocompetent patients had only moderate or mild CMV involvement.


CONCLUSIONS
It appears that CMV-positive cells were present in all groups studied, suggesting that CMV-infected cells alone are not sufficient to make the diagnosis of CMV disease in the transplanted host. Moreover, the clinical symptoms and the intensity of the histologic CMV findings did not correlate with the symptoms the patients were having. In kidney transplant recipients, it emerges that CMV is activated more easily in the upper rather than in the lower gastrointestinal tract.
Lempinen
Marko
M
Department of Transplantation and Liver Surgery, and Transplant Unit Research Laboratory, Helsinki University Hospital, Helsinki, Finland. marko.lempinen@hus.fi
Halme
Leena
L
Sarkio
Susanna
S
Arola
Johanna
J
Honkanen
Eero
E
Turunen
Ulla
U
Salmela
Kaija
K
Lautenschlager
Irmeli
I
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000956:Antigens, Viral / Q000097:blood; D003587:Cytomegalovirus / Q000302:isolation & purification*; D004724:Endoscopy; D005260:Female; D005753:Gastric Mucosa / Q000473:pathology; D041981:Gastrointestinal Tract / Q000821:virology*; D006801:Humans; D007121:Immunocompetence; D007413:Intestinal Mucosa / Q000473:pathology; D007676:Kidney Failure, Chronic / Q000821:virology*; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged
D000956:Antigens, Viral