OPPORTUNISTIC UPPER GASTROINTESTINAL INFECTION IN TRANSPLANT RECIPIENTS

Opportunistic infection of the upper gastrointestinal tract by cytomeg alovirus (CMV) or invasive fungal infection was studied in 219 consecu tive kidney and kidney/pancreas transplant recipients with regard to i ncidence, presentation, and clinical outcome. Prompt upper endoscopy w as done in all patients with these symptoms: dyspepsia, dysphagia, or bleeding. Multiple biopsies were obtained for fungal culture, CMV cult ure, CMV assay, and histologic examination for fungal invasion. Betwee n April 1991 and July 1993, 57/219 (26%) transplant patients developed upper gastrointestinal symptoms. At endoscopy, gross mucosal abnormal ity was evident in 48/57 (84%). Opportunistic infection was found in 2 1/48 (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 invasi ve fungal infection in 8/57 (14%). All 23 infections were successfully eradicated. Opportunistic infection occurred in 12/31 (39%) with dysp epsia, 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 funct ion, all patients with upper gastrointestinal tract symptoms require p rompt endoscopy and biopsy to effect appropriate therapy. Random biops y is also recommended in the face of a normal endoscopic examination.