Prevalence of cytomegalovirus in the gastrointestinal tract of renal transplant recipients with persistent abdominal pain

Am J Kidney Dis. 1999 Jul;34(1):65-8. doi: 10.1016/s0272-6386(99)70110-1.

Abstract

Abdominal pain occurs frequently in renal transplant recipients receiving mycophenolate mofetil (MMF) therapy. The cause of this abdominal pain has not been fully elucidated, but may involve local irritation, as well as inhibition of rapidly dividing cells of the gastrointestinal (GI) tract. This milieu of inflammation and added immunosuppression is conducive to activation of cytomegalovirus (CMV). We therefore sought to find the prevalence of active CMV in patients presenting with abdominal pain on maintenance MMF therapy. All patients receiving a renal transplant at our center from March 1, 1997, to September 1, 1997, were studied. Any patient presenting with midepigastric pain for greater than 3 days underwent esophagogastroduodenoscopy (EGD) with biopsy. CMV was diagnosed by the presence of inclusion bodies and immunohistochemical studies. Ten patients presented with persistent midepigastric pain; nine of these patients had evidence of GI CMV. Patients who were CMV negative and received an allograft from CMV-positive donors and those with leukopenia were at significantly increased risk for the development of abdominal pain. In our study population, the majority of patients on maintenance MMF therapy who presented with persistent midepigastric pain had evidence of active CMV infection in the upper gastrointestinal tract.

MeSH terms

  • Abdominal Pain / etiology*
  • Adult
  • Cytomegalovirus Infections / complications*
  • Cytomegalovirus Infections / diagnosis
  • Cytomegalovirus Infections / epidemiology
  • Digestive System / virology
  • Female
  • Humans
  • Immunosuppressive Agents / adverse effects
  • Immunosuppressive Agents / therapeutic use*
  • Incidence
  • Kidney Transplantation*
  • Logistic Models
  • Male
  • Mycophenolic Acid / adverse effects
  • Mycophenolic Acid / analogs & derivatives*
  • Mycophenolic Acid / therapeutic use
  • Prevalence
  • Risk Factors

Substances

  • Immunosuppressive Agents
  • Mycophenolic Acid