INCREASED INTESTINAL PERMEABILITY DURING CYTOMEGALOVIRUS-INFECTION INRENAL-TRANSPLANT RECIPIENTS

Cytomegalovirus (CMV) infections in renal transplant recipients can af fect the gastrointestinal trace, but significant clinical manifestatio ns are seldom seen. We hypothesize that subclinical involvement of the gastrointestinal tract may be quite frequent during CMV infection. In order to study this, we measured intestinal permeability by calculati ng the urinary lactulose mannitol (LM) excretion ratio after oral admi nistration of lactulose and mannitol (normal < 0.030) in patients with symptomatic and asymptomatic CMV infection. A total of 111 patients w ere enrolled in the study, 104 of whom were tested on postoperative da y (POD) 10. Twenty-nine patients developed CMV infection, 12 of whom c ould be studied with the permeability test (median POD 40). Another ni ne patients without CMV infection were also studied at day 40 and serv ed as controls. The LM ratio increased significantly during CMV infect ion compared to measurements before active infection (median 0.060 vs. 0.030, P < 0.01) and was significantly higher during the infection th an in the control group (median 0.007, P < 0.01). No correlation could be found between the LM ratio and viral load, humoral response to the virus, or symptomatology of infection. We conclude that an increased intestinal permeability is found in a substantial number of patients w ith an active, albeit asymptomatic, CMV infection after renal transpla ntation. Pathophysiological mechanisms and clinical implications remai n speculative but will be subject to further study.