Prevalence of cytomegalovirus in the gastrointestinal tract of renal transplant recipients with persistent abdominal pain

Abdominal pain occurs frequently in renal transplant recipients receiving m ycophenolate mofetil (MMF) therapy. The cause of this abdominal pain has no t been fully elucidated, but may involve local irritation, as well as inhib ition of rapidly dividing cells of the gastrointestinal (GI) tract; This mi lieu of inflammation and added immunosuppression is conducive to activation of cytomegalovirus (CMV). We therefore sought to find the prevalence of ac tive CMV in patients presenting with abdominal pain on maintenance MMF ther apy. All patients receiving a renal transplant at our center from March 1, 1997, to September 1, 1997, were studied. Any patient presenting with midep igastric pain for greater than 3 days underwent esophagogastroduodenoscopy (EGD) with biopsy. CMV was diagnosed by the presence of inclusion bodies an d immunohistochemical studies. Ten patients presented with persistent midep igastric pain; nine of these patients had evidence of GI CMV. Patients who were CMV negative and received an allograft from CMV-positive donors and th ose with leukopenia were at significantly increased risk for the developmen t of abdominal pain. In our study population, the majority of patients on m aintenance MMF therapy who presented with persistent midepigastric pain had evidence of active CMV infection in the upper gastrointestinal tract. (C) 1999 by the National Kidney Foundation, Inc.