Invasive CMV-Infection of the Duodenal Cuff – An Underestimated Entity of CMV Infection and Its Potential Impact On Outcome After Pancreas Transplantation
1Transplantation, Surgical Sciences, Uppsala, Sweden
2Medical Scinces, Upsala, Sweden
3Genetics and Pathology, Uppsala, Sweden.
Meeting: 2015 American Transplant Congress
Abstract number: 12
Keywords: Cytomeglovirus, Graft failure, Pancreas transplantation
Session Information
Session Name: Concurrent Session: Controversies in Pancreas Transplantation
Session Type: Concurrent Session
Date: Sunday, May 3, 2015
Session Time: 2:15pm-3:45pm
Presentation Time: 3:27pm-3:39pm
Location: Room 122-AB
Introduction
We present data on the incidence of focal invasive CMV-infection of the duodenal cuff and its potential impact on clinical outcome after pancreas transplantation (PT).
Material and method
From January 2010 to December 2013, 69 diabetic patients underwent simultaneous pancreas and kidney (n= 54), pancreas after kidney (n= 11) and PT alone (n= 4). Three patients with technical failure were excluded. Sixty-five patients underwent serial biopsies of duodenal cuff at 0-3, 6 and 12 months post-transplant by double balloon enteroscopy (DBE, n= 61) and cystoscopy (n= 4). In 4 patients, no serial biopsies were obtained due to death, refusal and inaccessibility of duodenal cuff.
Results
Overall, 185 duodenal biopsies were obtained, 23/69 patients developed CMV-infection, 18/23 had CMV-disease. Among these patients, 12/18 had CMV-syndrome with CMV-DNAemia and attributable symptoms. In 6/18 patients with CMV-DNAemia/symptoms, CMV was also detected in the duodenal cuff. In 5 patients, a subclinical invasive CMV infection of the duodenal cuff (SICD) was presented with no CMV-DNAemia. Pancreas graft failure occurred in 6 cases at a median follow-up of 625 days; 5/6 cases suffered from CMV-infection (CMV-duodenitis n= 3, CMV-pneumonia n= 1, CMV-syndrome n= 1). One patient with CMV-duodenitis presented with spontaneous perforation of duodenal cuff on day 23. The median time from transplant to CMV-duodenitis was 111 days (16-282). Fifty-two of 69 patients received prophylaxis with valaciclovir (VACV) with for a median of 87 days (15-211). Thirteen of 69 patients were given valganciclovir (VGCV) for a median of 140 days (82-197). Four patients received no prophylaxis. There were no differences in age, sex, BMI, transplant modality, pre-transplant immunization, immunosuppression and CMV-serostatus between VACV and VGCV subgroups. CMV-duodenitis and graft failure occurred in VACV-group only.
Conclusions
Invasive CMV-infection of the duodenal cuff is an early infectious complication that can be associated with morbidity and graft loss post PT. Furthermore, CMV-infection can occur as SICD in absence of CMV-DNAemia, attributable symptom and graft dysfunction. This entity of CMV-infection is not defined in the international guidelines on definition of tissue invasive CMV-disease.
To cite this abstract in AMA style:
Biglarnia A, Zur-Mühlen Bvon, Yamamoto S, Berglund D, Wagner M, Sedigh A, Tufveson G, Larsson E, Sund F. Invasive CMV-Infection of the Duodenal Cuff – An Underestimated Entity of CMV Infection and Its Potential Impact On Outcome After Pancreas Transplantation [abstract]. Am J Transplant. 2015; 15 (suppl 3). https://atcmeetingabstracts.com/abstract/invasive-cmv-infection-of-the-duodenal-cuff-an-underestimated-entity-of-cmv-infection-and-its-potential-impact-on-outcome-after-pancreas-transplantation/. Accessed May 13, 2025.« Back to 2015 American Transplant Congress