CMV allograft pancreatitis - Diagnosis, treatment, and histological features

Background. Cytomegalovirus (CMV) infection is a common problem in solid or gan transplant recipients. CMV infection of pancreas allografts is not, how ever, well described. Methods. We report the clinical presentation, histologic findings, treatmen t, and outcome in four patients with CMV allograft pancreatitis. These pati ents presented 18 weeks to 44 months after transplantation with elevated se rum amylase and lipase and were suspected to have acute rejection. Percutan eous pancreas allograft biopsy specimens showed evidence of tissue invasive CMV infection. One patient had simultaneous CMV infection and acute reject ion. Results. Prolonged treatment with ganciclovir resulted in clinical and hist ologic resolution of the CMV disease. Rejection was successfully treated. P rimary CMV infection in seronegative recipients seemed to be a risk factor. Three patients maintain normal allograft function; one patient lost functi on due to chronic rejection. The histology of tissue-invasive CMV pancreas allograft infection and its differentiation from acute rejection is describ ed. Conclusion. Prompt diagnosis and prolonged therapy with antiviral agents ca n result in maintenance of allograft function.