Gastrointestinal cytomegalovirus disease in renal transplant recipients: a case series

The purpose of this article was to report a series of 23 renal transplant recipients with histologically proven and immunohistochemically confirmed cytomegalovirus (CMV) lesions in the gastrointestinal tract (GIT) and to assess the risk factors associated with severe disease/mortality. CMV patients (n = 23) were allocated into two groups: those who died (n = 6) and those considered cured (n = 17). Overall mortality rate was 26% (6/23). Initial symptoms suggestive of lower GIT involvement were observed in all death cases and in 35.3% of those cured (p = 0.01). Enterorrhagia was seen in 83.3% of the patients who died. Death risk increased twofold (RR 2 [1.13-3.52], p = 0.01) when symptoms of lower GIT involvement were initially observed and sixfold when enterrohagia was present (RR 6 [1.1-35.9], p = 0.001). Among death cases, mean time at diagnosis was significantly more distant (2002 +/- 2.9 x 2008 +/- 1.6, p = 0.04). The difference in mortality rates seen as service practices changed along the years demonstrates the importance of early diagnosis.