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CMV allograft pancreatitis: diagnosis, treatment, and histological features
D K Klassen1, C B Drachenberg, J C Papadimitriou
1Department of Medicine, University of Maryland Medical System, Baltimore 21201, USA.
Background:
Cytomegalovirus (CMV) infection is a common problem in solid organ transplant recipients. CMV infection of pancreas allografts is not, however, well described.
Methods:
We report the clinical presentation, histologic findings, treatment, and outcome in four patients with CMV allograft pancreatitis. These patients presented 18 weeks to 44 months after transplantation with elevated serum amylase and lipase and were suspected to have acute rejection. Percutaneous pancreas allograft biopsy specimens showed evidence of tissue invasive CMV infection. One patient had simultaneous CMV infection and acute rejection.
Results:
Prolonged treatment with ganciclovir resulted in clinical and histologic resolution of the CMV disease. Rejection was successfully treated. Primary CMV infection in seronegative recipients seemed to be a risk factor. Three patients maintain normal allograft function; one patient lost function due to chronic rejection. The histology of tissue-invasive CMV pancreas allograft infection and its differentiation from acute rejection is described.
Conclusion:
Prompt diagnosis and prolonged therapy with antiviral agents can result in maintenance of allograft function.
Insights
Cytomegalovirus (CMV) infection in pancreas transplants is uncommon but treatable. Prompt diagnosis and ganciclovir therapy can preserve pancreas allograft function, even with co-occurring rejection.
Area of Science:
- Transplant Surgery
- Infectious Diseases
- Gastroenterology
Background:
- Cytomegalovirus (CMV) infection is a significant concern for solid organ transplant recipients.
- CMV infection specifically affecting pancreas allografts is infrequently documented.
Purpose of the Study:
- To describe the clinical presentation, histology, treatment, and outcomes of CMV infection in pancreas allograft pancreatitis.
- To highlight the diagnostic challenges and management strategies for this rare complication.
Main Methods:
- Case series of four patients with CMV allograft pancreatitis.
- Clinical data, laboratory results, and histologic findings from pancreas allograft biopsies were analyzed.
- Treatment with ganciclovir and management of concurrent rejection were documented.
Main Results:
- Patients presented with elevated pancreatic enzymes, mimicking acute rejection.
- Tissue-invasive CMV infection was confirmed histologically in pancreas allograft biopsies.
- Prolonged ganciclovir treatment led to resolution of CMV disease and preserved allograft function in most cases.
- Primary CMV infection in seronegative recipients was identified as a potential risk factor.
Conclusions:
- Early diagnosis and sustained antiviral therapy are crucial for maintaining pancreas allograft function.
- Distinguishing CMV pancreatitis from acute rejection is essential for appropriate management.