Gastrointestinal cytomegalovirus infections in organ transplant recipients

Abstract

Cytomegalovirus (CMV) is a major pathogen for immunocompromised organ transplant recipients. 80 to 90% of all transplant recipients are infected by the virus; however, the incidence of CMV disease is 30 to 40%. Gastrointestinal CMV disease involving any part of the digestive tract occurs in about 10% of all patients receiving solid organ transplantation. Mucosal injury, ulcerations, erosions, haemorrhage, disorders of digestive tract motility, rarely gastrointestinal mass and perforation are the most common pathological findings in CMV disease. Diagnostics is based on endoscopy with mucosal biopsy. Histopathological examination of biopsy samples must look for specific cytomegalic cells with intranuclear (“owl's eye”) and intracytoplasmatic inclusions. Various microbiological, immunohistochemical and molecular biological assays can be performed to detect CMV in the mucosa. In established gastrointestinal CMV disease both gastroenterological and antiviral treatments are needed including intravenous ganciclovir and/or oral valganciclovir. Prevention of disease should be achieved by general prophylaxis in high-risk patients (oral valganciclovir, in special cases hyperimmune globulin); and in medium risk patients by pre-emptive therapy using microbiological surveillance.