Opportunistic upper gastrointestinal infection in transplant recipients

Abstract

Opportunistic infection of the upper gastrointestinal tract by cytomegalovirus (CMV) or invasive fungal infection was studied in 219 consecutive kidney and kidney/pancreas transplant recipients with regard to incidence, presentation, and clinical outcome. Prompt upper endoscopy was done in all patients with these symptoms: dyspepsia, dysphagia, or bleeding. Multiple biopsies were obtained for fungal culture, CMV culture, CMV assay, and histologic examination for fungal invasion. Between April 1991 and July 1993, 57/219 (26%) transplant patients developed upper gastrointestinal symptoms. At endoscopy, gross mucosal abnormality was evident in 48/57 (84%). Opportunistic infection was found in 21/48 (44%); however, CMV infection was also detected in 2/9 (22%) who had a normal study. Overall, CMV was present in 15/57 (26%) and invasive fungal infection in 8/57 (14%). All 23 infections were successfully eradicated. Opportunistic infection occurred in 12/31 (39%) with dyspepsia, 9/14 (64%) with dysphagia, and 2/12 (17%) with bleeding. Graft loss occurred in 5/23 (22%) with opportunistic infection vs 23/196 (12%) other recipients. Upper gastrointestinal symptoms are indicative of serious opportunistic infection in a significant number of transplant recipients. As opportunistic infection may jeopardize allograft function, all patients with upper gastrointestinal tract symptoms require prompt endoscopy and biopsy to effect appropriate therapy. Random biopsy is also recommended in the face of a normal endoscopic examination.

Gastrointestinal complications in renal transplant recipients detected by endoscopic biopsies in a developing country

“…Esophagitis in renal transplant recipients is mostly secondary to opportunistic infections by Candida, fungus, Herpes simplex, CMV, and rarely due to reflux disease [29]. Candidal esophagitis was the commonest esophageal disorder in renal transplant recipients in an earlier study [19]. This usually occurs within first 6 months after transplantation.…”

“…Almost all of the reported studies have been clinical-, endoscopy-, or autopsy-based [3][4][5][6][7][14][15][16][17][18][19]. Most of the reported studies have been carried out in cadaveric renal transplant recipients.…”

Symptoms and diagnosis of gallbladder stones

“…14 No definitive consensus exists for prophylactic cholecystectomy in asymptomatic gallstone patients undergoing solid organ transplantation, who are at increased risk of infections, drug side effects and malignancies. 15 Early cholecystectomy in these patients might be a reasonable strategy, although the timing and utility of cholecystectomy need to be further explored. 16,17 Other subgroups of patients might benefit from incidental cholecystectomy for asymptomatic gallstones, i.e.…”

Helicobacter pylori before and after the kidney transplantation

“…Although upper GI endoscopy is part of the everyday medical practice and endoscopic alterations of liver transplant recipients are the focus of numerous studies, only few studies have been done on the endoscopic findings of renal patients and include only small numbers [16,17]. Treatment of these complaints is based mainly on local habits and theories.…”