Diagnosis and treatment of cytomegalovirus disease in transplant patients based on gastrointestinal tract manifestations
J. L. Mayoral, C. M. Loeffler, C. G. Fasola, M. A. Kramer, W. J. Orrom, A. J. Matas, J. S. Najarian and D. L. Dunn
Department of Surgery, University of Minnesota, Minneapolis.
Infection due to cytomegalovirus is a substantial cause of morbidity and
mortality in immunocompromised patients. In particular, cytomegalovirus
infection has been associated with a significant detrimental effect on
patient and allograft survival after solid-organ transplantation. We are
evaluating a new antiviral agent, ganciclovir 9-[1,3-dihydroxy-2-2
propoxymethyl] guanine (DHPG), used in solid-organ transplant recipients
who developed life-threatening cytomegalovirus infections. Between March 1,
1987, and June 30, 1989, we treated 93 solid-organ transplant patients who
developed tissue-invasive cytomegalovirus disease. From this group of
patients we have identified 14 patients with primary gastrointestinal
cytomegalovirus disease who received treatment with DHPG. Tissue diagnosis
was made by endoscopy of the upper gastrointestinal tract (11 patients) or
colonoscopy (three patients). Invasive cytomegalovirus disease was
identified prior to severe complications of the gastrointestinal tract in
all but one patient, who suffered colonic perforation prior to treatment
with DHPG and subsequently died of bacterial sepsis. While 13 of the 14
patients improved after treatment with DHPG, four patients required
additional treatments for recurrent cytomegalovirus disease and recovered.
No DHPG toxicity was observed. We believe treatment with DHPG is indicated
in this patient population, but that further studies are indicated to fully
define the impact of this recommendation on both patient and allograft
survival after solid-organ transplantation.
