CYTOMEGALOVIRUS INFECTION OF THE UPPER GASTROINTESTINAL TRACT BEFORE AND AFTER LIVER TRANSPLANTATION

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Abstract
The prevalence of upper gastrointestinal CMV infection was determined in 90 adult transplant patients: 54 were evaluated prior to orthotopic liver transplantation (OLTx), while 36 were evaluated one to six weeks after OLTx. Upper gastrointestinal endoscopy, with biopsies of the stomach and duodenum for viral culture and histopathologic examination, was performed on each subject. Those without esophageal varices had their esophagus biopsied also for viral cultures and histopathologic examination. In addition, a gastric brushing for cytologic examination was obtained on all patients. All 90 patients studied were known to be CMV-seropositive prior to transplantation. Therefore all infections were considered to be reactivation infections. Gastrointestinal CMV infection was more common in patients studied post-OLTx (33%) than it was in those studied pre-OLTx (2%) (P <0.001). The presence of gastrointestinal CMV infection was associated with a decreased T lymphocyte helper/suppressor ratio in peripheral blood. CMV duodenal infections were associated with the presence of endoscopic and histologic inflammation. Of the various diagnostic methods utilized, viral cultures of intestinal tissue were found to be the most useful in establishing a diagnosis of infection.