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.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
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, 1992
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, 1992
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, 1989
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, 1994
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, 1994
Keating M, Wilhelm M, Walker R: Strategies for prevention of infection after cardiac transplantation. May Clin Proc 67:676–684, 1992
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, 1988
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, 1988
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, 1992
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, 1991
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, 1993
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, 1991
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, 1988
Goodgame R: Gastrointestinal cytomegalovirus disease. Ann Intern Med 119:924–935, 1993
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, 1989
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, 1989
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, 1985
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Slusser, S.O., Boehmer, J.P., Zurlo, J. et al. Questioning the clinical significance of upper gastrointestinal cytomegalovirus disease following heart transplantation. Digest Dis Sci 40, 1824–1830 (1995). https://doi.org/10.1007/BF02212708
Received:
Revised:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF02212708