Cytomegaloviral colitis in organ transplant recipients

Česká verzia

Authors: D. Kamenář; P. Drastich ; H. Gottfriedová; J. Malušková; J. Šperl ; P. Štirand; P. Trunečka; J. Špičák
Authors place of work: Institut klinické a experimentální medicíny IKEM
Published in the journal: Gastroent Hepatol 2011; 65(1): 26-29
Category: Clinical and Experimental Gastroenterology: Original Article

Summary

Purpose of the study:
A cytomegaloviral infection causes significant morbidity in organ transplant recipients. The most frequent type of impairment of immunosuppressed patients is CMV colitis. The definitive diagnosis of CMV colitis requires the immunohistochemical examination of tissue from affected parts of the colon. It is our aim to describe our experiences with such patients in our institute and evaluate the diagnostic and therapeutic options for CMV colitis.

Methods:
A total of 20 patients were identified in the electronic database of the Institute for Clinical and Experimental Medicine who had undergone organ transplantation and been hospitalised in IKEM with immunohistochemically confirmed CMV colitis in the period from January 2001 to December 2008. A retrospective evaluation was then made of the relevant data for these patients.

Results:
The group of 20 patients consisted of 8 men and 12 women with an average age of ±57.4 years, standard deviation 6.1 years, range 40–67 years. 12 patients had undergone a kidney transplantation, 5 a liver transplantation and 3 a heart transplantation. The average interval between the transplantation and endoscopic examination was 38.1 months (in the range 1–140 months, median 7 months). All patients were treated with immunosuppressants – corticoids and/or various combinations of mycophenolate mofetil, cyclosporine, tacrolimus or sirolimus. 15 patients showed acute diarrhoea, 3 patients had chronic diarrhoea, one patient presented with isolated hematochezia and the other with abdominal pain only. Four of nine patients who were evaluated were found to be positive for anti-CMV-IgM. All 20 patients were tested for the presence of an early CMV antigen or CMV DNA using the blood PCR method, with 11 positive cases. Endoscopic tests showed 4 types of impairment: erythema and edema (eleven patients), multiple isolated ulcers (2 patients), erythema and edema together with ulcers (5 patients) and the image of pseudomembanous colitis (2 patients). Histological examinations of lesions showed normal inflammatory changes with dominating mononuclear cellulisation. 13 patients showed typical inclusions. All 20 patients with CMV colitis were treated with glanciclovir and/or valganciclovir. 19 patients survived, one patient died from causes unrelated to CMV colitis.

Conclusion:
The diagnosis of CMV colitis in the recipients of organ transplants relies on an active diagnostic approach, including total colonoscopy, with biopsies of affected sections of the colon and their histological and immunohistochemical examination. This strategy provides early and definitive diagnosis and allows specific therapy of CMV colitis with highly effective antiviral agents in a timely manner.

Key words:
cytomegalovirus – colitis – ganciclovir – immunosuppresants – organ transplantation – valganciclovir

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