Digestive Diseases and Sciences

, Volume 40, Issue 8, pp 1824–1830 | Cite as

Questioning the clinical significance of upper gastrointestinal cytomegalovirus disease following heart transplantation

  • Stephen O. Slusser
  • John P. Boehmer
  • John Zurlo
  • Francesca Ruggiero
  • Ann Ouyang
Liver: Cirrhosis, Fibrosis, Portal Hypertension, and Transplantation

Abstract

We performed a retrospective review of patients who underwent esophagogastroduodenoscopy after heart transplantation to determine the clinical setting in which upper gastrointestinal cytomegalovirus disease is identified. No gastrointestinal cytomegalovirus disease was found prior to transplant 51 and this period (from transplant 1 to 50) corresponded to a time when significantly fewer esophagogastroduodenoscopies included biopsy. Patients in whom cytomegalovirus was identified were more likely to have been CMV seronegative and to have received a heart from a seropositive donor (60% vs 20%,P=0.029). In addition, patients with cytomegalovirus used aspirin more commonly (90% vs 31%,P=0.001), and underwent esophagogastroduodenoscopy earlier after transplantation (123d vs 652d,P=0.029). We conclude that factors that increase the use of esophagogastroduodenoscopy and biopsy in the early transplant period increase the likelihood of identifying cytomegalovirus in gastrointestinal tissue. However, the clinical course and significance of cytomegalovirus identified in the upper gastrointestinal tract in heart transplant patients may be difficult to discern.

Key Words

cytomegalovirus heart transplantation peptic ulcer disease esophagogastroduodenoscopy 

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References

  1. 1.
    Costanzo-Nordin M, Swinnen L, Fisher S, O'Sullivan E, Pifarre R, Heroux A, Mullen G, Johnson M: Cytomegalovirus infections in heart transplant recipients: Relationship to immunosuppression. J Heart Lung Transplant 11:837–846, 1992Google Scholar
  2. 2.
    Kendall T, Wilson J, Rudio S, Kandolf R, Gulizia J, Winters G, Costanzo-Nordin M, Malcolm G, Thieszen S, Miller L, McManun B: Cytomegalovirus and other herpesviruses: Do they have a role in the development of accelerated coronary arterial disease in human heart allografts? J Heart Lung Transplant 11:514–520, 1992Google Scholar
  3. 3.
    McDonald K, Rector T, Braunlin E, Kubo S, Olivari M: Association of coronary artery disease in cardiac transplant recipients with cytomegalovirus infection. Am J Cardiol 64:356–362, 1989Google Scholar
  4. 4.
    Mayoral J, Loeffler C, Fasola C, Kramer M, Orrom W, Matas A, Najarian J, Dunn D: Diagnosis and treatment of cytomegalovirus disease in transplant patients based on gastrointestinal tract manifestations. Arch Surg 126:202–206, 1994Google Scholar
  5. 5.
    Kirklin J, Naftel D, Levine T, Bourge R, Pelletier G, O'Donnell J, Miller L, Pritzker M: Cytomegalovirus after heart transplantation. Risk factors for infection and death: A multiinstitutional study. J Heart Lung Transplant 13:394–404, 1994Google Scholar
  6. 6.
    Keating M, Wilhelm M, Walker R: Strategies for prevention of infection after cardiac transplantation. May Clin Proc 67:676–684, 1992Google Scholar
  7. 7.
    Wreghitt T, Hakim M, Gray J, Kucia S, Wallwork J, English T: Cytomegalovirus infections in heart and heart and lung transplant recipients. J Clin Pathol 41:660–667, 1988Google Scholar
  8. 8.
    Gorensek M, Stewart R, Keys T, McHenry M, Goormatic M: A multivariate analysis of the risk of cytomegalovirus infection in heart transplant recipients. J Infect Dis 157:515–522, 1988Google Scholar
  9. 9.
    Merigan T, Renlund D, Keay S, Bristow M, Starnes V, O'Connell J, Resta S, Dunn D, Gamberg P, Ratkovec R, Richenbacher W, Millar R, DuMond C, DeAmond B, Sullivan V, Cheney T, Buhles W, Stinson E: A controlled trial of ganciclovir to prevent cytomegalovirus disease after heart transplantation. N Engl J Med 326:1182–1186, 1992Google Scholar
  10. 10.
    Cooper D, Novitzky D, Schlegel V, Muchmore J, Cucchiara A, Zuhdi N: Successful management of symptomatic cytomegalo-virus disease with ganciclovir after heart transplantation. J Heart Lung Transplant 10:656–663, 1991Google Scholar
  11. 11.
    Arabia F, Rosado L, Hustom C, Sethi G, Copeland J: Incidence and recurrence of gastrointestinal cytomegalovirus infection in heart transplantation. Ann Thorac Surg 55:8–11, 1993Google Scholar
  12. 12.
    Cates J, Chavez M, Laks H, Drinkwater D, Stevenson L, Kobashigawa J, Saunders K, Abedin M, Roslyn J: Gastrointestinal complications after cardiac transplantation: A spectrum of diseases. Am J Gastroenterol 86:412–416, 1991Google Scholar
  13. 13.
    Colon R, Frasier O, Kahan B, Radovancevic B, Duncan J, Lorber M, Van Buren C: Complications in cardiac transplant patients requiring general surgery. Surgery 103:32–38, 1988Google Scholar
  14. 14.
    Goodgame R: Gastrointestinal cytomegalovirus disease. Ann Intern Med 119:924–935, 1993Google Scholar
  15. 15.
    Kaplan C, Petersen E, Icenogle T, Copeland J, Villar H, Sampliner R, Minnich L, Ray C: Gastrointestinal cytomegalovirus infection in heart and heart-lung transplant recipients. Arch Intern Med 149:2095–2100, 1989Google Scholar
  16. 16.
    Villar H, Neal D, Levinson M, Fuller J, Emery R, Graham A, Copeland J, Rhenman M, Copeland JG: Gastrointestinal complications after human transplantation and mechanical heart replacement. Am J Surg 157:168–174, 1989Google Scholar
  17. 17.
    Cohen E, Komorowski R, Kauffman H, Adams M: Unexpectedly high incidence of cytomegalovirus infection in apparent peptic ulcers in renal transplant recipients. Surgery 97:606–612, 1985Google Scholar

Copyright information

© Plenum Publishing Corporation 1995

Authors and Affiliations

  • Stephen O. Slusser
    • 1
    • 2
    • 3
    • 4
  • John P. Boehmer
    • 1
    • 2
    • 3
    • 4
  • John Zurlo
    • 1
    • 2
    • 3
    • 4
  • Francesca Ruggiero
    • 1
    • 2
    • 3
    • 4
  • Ann Ouyang
    • 1
    • 2
    • 3
    • 4
  1. 1.Division of Gastroenterology, in the Department of MedicineThe pennsylvania State UniversityHershey
  2. 2.Division of Cardiology, in the Department of MedicineThe pennsylvania State UniversityHershey
  3. 3.Division of Infectious Disease, in the Department of MedicineThe pennsylvania State UniversityHershey
  4. 4.Department of Pathology, The Milton S. Hershey Medical CenterThe pennsylvania State UniversityHershey

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