Immunohistochemistry Staining-Proven Cytomegalovirus Colitis in Living Donor Liver Transplantation
Abstract
:1. Introduction
2. Methods
2.1. Study Population and Design
2.2. Data Collection and Diagnostic Assessment
2.3. Ethical Statement
2.4. Statistical Analysis
3. Results
3.1. Demographics and Clinical Characteristics of all Patients with Biopsy-Proven CMV Colitis
3.2. Comparison between CMV DNAemia and Non-CMV DNAemia
3.3. Comparison of CMV Colitis between Patients with and without Living Donor Liver Transplantation
3.4. CMV Colitis in Living Donor Liver Transplantation
4. Discussion
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
- Martin, P.; DiMartini, A.; Feng, S.; Brown, R., Jr.; Fallon, M. Evaluation for liver transplantation in adults: 2013 practice guideline by the American Association for the Study of Liver Diseases and the American Society of Transplantation. Hepatology 2014, 59, 1144–1165. [Google Scholar] [CrossRef] [PubMed]
- Liu, P.Y.; Cheng, S.B.; Lin, C.C.; Lin, C.H.; Chang, S.N.; Cheng, C.Y.; Shi, Z.Y.; Tung, K.C.; Wu, M.J. Cytomegalovirus disease after liver transplantation: A nationwide population-based study. Transplant. Proc. 2014, 46, 832–834. [Google Scholar] [CrossRef] [PubMed]
- EASL Clinical Practice Guidelines: Liver transplantation. J. Hepatol. 2016, 64, 433–485. [CrossRef] [PubMed]
- Herman, D.; Han, H. Cytomegalovirus in liver transplant recipients. Curr. Opin. Organ Transplant. 2017, 22, 345–350. [Google Scholar] [CrossRef] [PubMed]
- Yadav, S.K.; Saigal, S.; Choudhary, N.S.; Saha, S.; Sah, J.K.; Saraf, N.; Kumar, N.; Goja, S.; Rastogi, A.; Bhangui, P.; et al. Cytomegalovirus infection in living donor liver transplant recipients significantly impacts the early post-transplant outcome: A single center experience. Transpl. Infect. Dis. 2018, 20, e12905. [Google Scholar] [CrossRef]
- Engelmann, C.; Sterneck, M.; Weiss, K.H.; Templin, S.; Zopf, S.; Denk, G.; Eurich, D.; Pratschke, J.; Weiss, J.; Braun, F.; et al. Prevention and Management of CMV Infections after Liver Transplantation: Current Practice in German Transplant Centers. J. Clin. Med. 2020, 9, 2352. [Google Scholar] [CrossRef]
- Razonable, R.R.; Humar, A. Cytomegalovirus in solid organ transplant recipients-Guidelines of the American Society of Transplantation Infectious Diseases Community of Practice. Clin. Transplant. 2019, 33, e13512. [Google Scholar] [CrossRef]
- Yeh, P.J.; Wu, R.C.; Chiu, C.T.; Lai, M.W.; Chen, C.M.; Pan, Y.B.; Su, M.Y.; Kuo, C.J.; Lin, W.R.; Le, P.H. Cytomegalovirus Diseases of the Gastrointestinal Tract. Viruses 2022, 14, 352. [Google Scholar] [CrossRef]
- Yoon, J.; Lee, J.; Kim, D.S.; Lee, J.W.; Hong, S.W.; Hwang, H.W.; Hwang, S.W.; Park, S.H.; Yang, D.H.; Ye, B.D.; et al. Endoscopic features and clinical outcomes of cytomegalovirus gastroenterocolitis in immunocompetent patients. Sci. Rep. 2021, 11, 6284. [Google Scholar] [CrossRef]
- Wetwittayakhlang, P.; Rujeerapaiboon, N.; Wetwittayakhlung, P.; Sripongpun, P.; Pruphetkaew, N.; Jandee, S.; Chamroonkul, N.; Piratvisuth, T. Clinical Features, Endoscopic Findings, and Predictive Factors for Mortality in Tissue-Invasive Gastrointestinal Cytomegalovirus Disease between Immunocompetent and Immunocompromised Patients. Gastroenterol. Res. Pract. 2021, 2021, 8886525. [Google Scholar] [CrossRef]
- Ljungman, P.; Boeckh, M.; Hirsch, H.H.; Josephson, F.; Lundgren, J.; Nichols, G.; Pikis, A.; Razonable, R.R.; Miller, V.; Griffiths, P.D. Definitions of Cytomegalovirus Infection and Disease in Transplant Patients for Use in Clinical Trials. Clin. Infect. Dis. 2017, 64, 87–91. [Google Scholar] [CrossRef] [Green Version]
- Gupta, E.; Pamecha, V.; Verma, Y.; Kumar, N.; Rastogi, A.; Hasnian, N.; Bhadoria, A.S. Pre-transplant cytomegalovirus immunoglobulin G antibody levels could prevent severe cytomegalovirus infections post-transplant in liver transplant recipients: Experience from a tertiary care liver centre. Indian J. Med. Microbiol. 2017, 35, 499–503. [Google Scholar] [CrossRef]
- Chen, D.; Zhao, R.; Cao, W.; Zhou, W.; Jiang, Y.; Zhang, S.; Chen, Y.; Fei, G.; Li, J.; Qian, J. Clinical characteristics of cytomegalovirus gastritis: A retrospective study from a tertiary medical center. Medicine 2020, 99, e18927. [Google Scholar] [CrossRef]
- Yeh, P.J.; Chiu, C.T.; Lai, M.W.; Wu, R.C.; Chen, C.M.; Kuo, C.J.; Hsu, J.T.; Su, M.Y.; Lin, W.P.; Chen, T.H.; et al. Clinical manifestations, risk factors, and prognostic factors of cytomegalovirus enteritis. Gut Pathog. 2021, 13, 53. [Google Scholar] [CrossRef]
- Beswick, L.; Ye, B.; van Langenberg, D.R. Toward an Algorithm for the Diagnosis and Management of CMV in Patients with Colitis. Inflamm. Bowel. Dis. 2016, 22, 2966–2976. [Google Scholar] [CrossRef] [Green Version]
- Fakhreddine, A.Y.; Frenette, C.T.; Konijeti, G.G. A Practical Review of Cytomegalovirus in Gastroenterology and Hepatology. Gastroenterol. Res. Pract. 2019, 2019, 6156581. [Google Scholar] [CrossRef] [Green Version]
- Yokoyama, Y.; Yamakawa, T.; Hirano, T.; Kazama, T.; Hirayama, D.; Wagatsuma, K.; Nakase, H. Current Diagnostic and Therapeutic Approaches to Cytomegalovirus Infections in Ulcerative Colitis Patients Based on Clinical and Basic Research Data. Int. J. Mol. Sci. 2020, 21, 2438. [Google Scholar] [CrossRef] [Green Version]
- Chaemsupaphan, T.; Limsrivilai, J.; Thongdee, C.; Sudcharoen, A.; Pongpaibul, A.; Pausawasdi, N.; Charatcharoenwitthaya, P. Patient characteristics, clinical manifestations, prognosis, and factors associated with gastrointestinal cytomegalovirus infection in immunocompetent patients. BMC Gastroenterol. 2020, 20, 22. [Google Scholar] [CrossRef] [Green Version]
- Yerushalmy-Feler, A.; Padlipsky, J.; Cohen, S. Diagnosis and Management of CMV Colitis. Curr. Infect. Dis. Rep. 2019, 21, 5. [Google Scholar] [CrossRef]
- Zhan, C.; Wang, W.; Chen, L. Predictive significance of neutrophil-to-lymphocyte and platelet-to-lymphocyte for cytomegalovirus infection in infants less than 3 months: A retrospective study. J. Clin. Lab. Anal. 2022, 36, e24131. [Google Scholar] [CrossRef]
- Khalid, A.; Ali Jaffar, M.; Khan, T.; Abbas Lail, R.; Ali, S.; Aktas, G.; Waris, A.; Javaid, A.; Ijaz, N.; Muhammad, N. Hematological and biochemical parameters as diagnostic and prognostic markers in SARS-COV-2 infected patients of Pakistan: A retrospective comparative analysis. Hematology 2021, 26, 529–542. [Google Scholar] [CrossRef]
- Zhu, R.; Chen, C.; Wang, Q.; Zhang, X.; Lu, C.; Sun, Y. Routine blood parameters are helpful for early identification of influenza infection in children. BMC Infect. Dis. 2020, 20, 864. [Google Scholar] [CrossRef] [PubMed]
- Yang, A.P.; Liu, J.P.; Tao, W.Q.; Li, H.M. The diagnostic and predictive role of NLR, d-NLR and PLR in COVID-19 patients. Int. Immunopharmacol. 2020, 84, 106504. [Google Scholar] [CrossRef] [PubMed]
- Bruminhent, J.; Razonable, R.R. Management of cytomegalovirus infection and disease in liver transplant recipients. World J. Hepatol. 2014, 6, 370–383. [Google Scholar] [CrossRef]
- Vutien, P.; Perkins, J.; Biggins, S.W.; Reyes, J.; Imlay, H.; Limaye, A.P. Association of Donor and Recipient Cytomegalovirus Serostatus on Graft and Patient Survival in Liver Transplant Recipients. Liver Transpl. 2021, 27, 1302–1311. [Google Scholar] [CrossRef]
- Yadav, S.K.; Saigal, S.; Choudhary, N.S.; Saha, S.; Kumar, N.; Soin, A.S. Cytomegalovirus Infection in Liver Transplant Recipients: Current Approach to Diagnosis and Management. J. Clin. Exp. Hepatol. 2017, 7, 144–151. [Google Scholar] [CrossRef]
- Lizaola-Mayo, B.C.; Rodriguez, E.A. Cytomegalovirus infection after liver transplantation. World J. Transplant. 2020, 10, 183–190. [Google Scholar] [CrossRef]
- Jang, E.; Park, S.Y.; Lee, E.J.; Song, E.H.; Chong, Y.P.; Lee, S.; Choi, S.-H.; Woo, J.H.; Kim, Y.S.; Kim, S. Diagnostic Performance of the Cytomegalovirus (CMV) Antigenemia Assay in Patients with CMV Gastrointestinal Disease. Clin. Infect. Dis. 2009, 48, e121–e124. [Google Scholar] [CrossRef] [Green Version]
- Bruminhent, J.; Thongprayoon, C.; Dierkhising, R.A.; Kremers, W.K.; Theel, E.S.; Razonable, R.R. Risk factors for cytomegalovirus reactivation after liver transplantation: Can pre-transplant cytomegalovirus antibody titers predict outcome? Liver Transpl. 2015, 21, 539–546. [Google Scholar] [CrossRef]
- Kirisri, S.; Vongsakulyanon, A.; Kantachuvesiri, S.; Razonable, R.R.; Bruminhent, J. Predictors of CMV Infection in CMV-Seropositive Kidney Transplant Recipients: Impact of Pretransplant CMV-Specific Humoral Immunity. Open Forum Infect. Dis. 2021, 8, ofab199. [Google Scholar] [CrossRef]
- McCoy, M.H.; Post, K.; Sen, J.D.; Chang, H.Y.; Zhao, Z.; Fan, R.; Chen, S.; Leland, D.; Cheng, L.; Lin, J. qPCR increases sensitivity to detect cytomegalovirus in formalin-fixed, paraffin-embedded tissue of gastrointestinal biopsies. Hum. Pathol. 2014, 45, 48–53. [Google Scholar] [CrossRef]
- Suárez-Lledó, M.; Marcos, M.; Cuatrecasas, M.; Bombi, J.A.; Fernández-Avilés, F.; Magnano, L.; Martínez-Cibrián, N.; Llobet, N.; Rosiñol, L.; Gutiérrez-García, G.; et al. Quantitative PCR Is Faster, More Objective, and More Reliable Than Immunohistochemistry for the Diagnosis of Cytomegalovirus Gastrointestinal Disease in Allogeneic Stem Cell Transplantation. Biol. Blood Marrow Transplant. 2019, 25, 2281–2286. [Google Scholar] [CrossRef]
- Mills, A.M.; Guo, F.P.; Copland, A.P.; Pai, R.K.; Pinsky, B.A. A comparison of CMV detection in gastrointestinal mucosal biopsies using immunohistochemistry and PCR performed on formalin-fixed, paraffin-embedded tissue. Am. J. Surg. Pathol. 2013, 37, 995–1000. [Google Scholar] [CrossRef]
Category | All Patients (n = 55) |
---|---|
Age, mean ± SD (range) (years) | 68.0 ± 15.68 (17–97) |
Gender | |
Male, n (%) | 28 (50.9) |
Female, n (%) | 27 (49.1) |
Clinical symptoms | |
Bloody stool, n (%) | 35 (63.7) |
Diarrhea, n (%) | 13 (23.6) |
Abdominal pain, n (%) | 10 (18.2) |
Fever, n (%) | 8 (14.5) |
Lesion site | |
Cecum, n (%) | 8 (14.5) |
Ascending colon, n (%) | 8 (14.5) |
Transverse colon, n (%) | 5 (9.1) |
Descending colon, n (%) | 11 (20) |
Sigmoid colon, n (%) | 12(21.8) |
Rectum, n (%) | 24 (43.6) |
Serum laboratory test | |
N/L ration, mean ± SD | 10.80 ± 20.70 |
Anti-CMV IgM | |
Positive, n (%) | 3 (5.5) |
Negative, n (%) | 22 (40) |
Not available, n (%) | 30 (54.5) |
Anti-CMV IgG | |
Positive, n (%) | 21 (38.2) |
Negative, n (%) | 0 (0) |
Not available | 34 (61.8) |
CMV PCR DNA amplification assays | |
Positive, n (%) | 15 (27.3) |
Negative, n (%) | 15 (27.3) |
Not available, n (%) | 25 (45.4) |
Pathology | |
Inclusion bodies, n (%) | 32 (58.2) |
CMV IHC staining, n (%) | 55 (100) |
Anti-viral therapy | |
Ganciclovir, n (%) | 17 (30.9) |
Valganciclovir, n (%) | 12 (21.8) |
Ganciclovir plus Valganciclovir, n (%) | 10 (18.2) |
No treatment, n (%) | 16 (29.1) |
Complications | |
Perforation, n (%) | 2 (3.6) |
Category | CMV DNAemia (n = 15) | CMV Non-DNAemia (n = 15) | p Value |
---|---|---|---|
Age, mean ± SD (range) (years) | 62.6 ± 19.9 | 64.5 ± 16.3 | 0.77 |
Gender | 0.20 | ||
Male, n (%) | 6 (40) | 9 (60) | |
Female, n (%) | 9 (60) | 6 (40) | |
Underlying disease | |||
Ulcerative colitis, n (%) | 5 (33) | 5 (33) | 1.00 |
Sepsis, n (%) | 4 (26.7) | 3 (20) | 1.00 |
ESRD, n (%) | 1 (6.7) | 1 (6.7) | 1.00 |
Chemotherapy for cancer, n (%) | 4 (26.7) | 1 (6.7) | 0.33 |
AIDS, n (%) | 0 (0) | 4 (20) | 0.10 |
DM, n (%) | 0 (0) | 2 (13.3) | 0.48 |
LDLT, n (%) | 1 (6.7) | 1 (6.7) | 1.00 |
SLE, n (%) | 0 (0) | 0 (0) | 1.00 |
Clinical symptoms | |||
Bloody stool, n (%) | 7 (46.7) | 6 (40) | 1.00 |
Diarrhea, n (%) | 4 (26.7) | 4 (26.7) | 1.00 |
Abdominal pain, n (%) | 6 (40) | 3 (20) | 0.43 |
Fever, n (%) | 1 (6.7) | 2 (13.3) | 1.00 |
Lesion site | |||
Cecum, n (%) | 3 (20) | 1 (6.7) | 0.60 |
Ascending colon, n (%) | 1 (6.7) | 1 (6.7) | 1.00 |
Transverse colon, n (%) | 1 (6.7) | 2 (13.3) | 1.00 |
Descending colon, n (%) | 3 (20) | 4 (26.7) | 1.00 |
Sigmoid colon, n (%) | 4 (26.7) | 4 (26.7) | 1.00 |
Rectum, n (%) | 6 (40) | 7 (46.7) | 1.00 |
Serum laboratory test | |||
N/L ratio, mean ± SD | 13.2 ± 24.5 | 3.5 ± 2.9 | 0.14 |
Anti-CMV IgM | |||
Positive, n (%) | 2 (13.3) | 1 (6.7) | 1.00 |
Negative, n (%) | 9 (60) | 9 (60) | 1.00 |
Not available, n (%) | 4 (26.7) | 5 (33.3) | 1.00 |
Anti-CMV IgG | |||
Positive, n (%) | 8 (53.3) | 9 (60) | 1.00 |
Negative, n (%) | 0 (0) | 0 (0) | 1.00 |
Not available, n (%) | 7 (46.7) | 6 (40) | 1.00 |
Pathology | |||
Inclusion bodies, n (%) | 11 (73.3) | 9 (60) | 0.7 |
CMV IHC staining, n (%) | 15 (100) | 15 (100) | 1.00 |
Anti-viral therapy | |||
Ganciclovir, n (%) | 5 (33.3) | 5 (33.3) | 1.00 |
Valganciclovir, n (%) | 3 (20) | 4 (26.7) | 1.00 |
Ganciclovir plus Valganciclovir, n (%) | 5 (33.3) | 3 (20) | 0.68 |
No treatment, n (%) | 2 (13.3) | 3 (20) | 1.00 |
Category | Subgroups of Non-LDLT | All Non-LDLT (n = 53) | LDLT (n = 2) | p Value | ||||||
---|---|---|---|---|---|---|---|---|---|---|
Sepsis (n = 13) | UC (n = 12) | ESRD (n = 11) | DM (n = 9) | Chemotherapy * (n = 8) | AIDS (n = 3) | SLE (n = 1) | ||||
Age, mean ± SD (range) (years) | 80.5 ± 10.7 | 63.9 ± 17.5 | 68.2 ± 7.5 | 70.6 ± 6.9 | 61.3 ± 18.4 | 40.3 ± 14.1 | 69 | 68.2 ± 15.9 | 63.0 ± 32.0 | 0.38 |
Gender | ||||||||||
Male, n (%)/Female, n (%) | 6 (46.2)/7 (53.8) | 5 (41.7)/7 (58.3) | 5 (45.5)/6 (54.5) | 3 (33.3)/6 (66.7) | 7 (87.5)/1 (12.5) | 3 (100.0)/0 (0) | 0 (0)/1 (100) | 27 (51.0)/26 (49.0) | 1 (50.0)/1 (50.0) | 1.00 |
Cancer history, n (%) | 1 (7.7) | 0 (0) | 0 (0) | 0 (0) | 8 (100) | 0 (0) | 0 (0) | 9 (17.0) | 1 (50.0) | 0.33 |
Clinical symptoms | ||||||||||
Bloody stool, n (%) | 6 (46.2) | 8 (66.7) | 9 (81.8) | 7 (77.8) | 4 (50) | 0 (0) | 1 (100) | 35 (66.0) | 0 (0) | 0.13 |
Diarrhea, n (%) | 5 (38.5) | 1 (8.3) | 2 (18.2) | 1 (11.1) | 1 (12.5) | 2 (66.7) | 0 (0) | 12 (22.6) | 1 (50) | 1.00 |
Abdominal pain, n (%) | 1 (7.7) | 2 (16.7) | 0 (0) | 2 (22.2) | 2 (25) | 1 (33.3) | 0 (0) | 8 (15.1) | 2 (100) | 1.00 |
Fever, n (%) | 2 (15.4) | 2 (16.7) | 1 (9.1) | 1 (11.1) | 2 (25) | 0 (0) | 0 (0) | 8 (15.1) | 0 (0) | 1.00 |
Lesion site | ||||||||||
Cecum, n (%) | 3 (23.1) | 0 (0) | 1 (9.1) | 0 (0) | 4 (50) | 0 (0) | 0 (0) | 8 (15.1) | 0 (0) | 1.00 |
Ascending colon, n (%) | 2 (15.4) | 1 (8.3) | 0 (0) | 0 (0) | 3 (37.5) | 1 (33.3) | 0 (0) | 7 (13.2) | 1 (50) | 1.00 |
Transverse colon, n (%) | 1 (7.7) | 0 (0) | 1 (9.1) | 1 (11.1) | 0 (0) | 0 (0) | 0 (0) | 3 (5.7) | 2 (100) | 0.11 |
Descending colon, n (%) | 2 (15.4) | 2 (16.7) | 2 (18.2) | 1 (11.1) | 2 (25) | 0 (0) | 1 (100) | 10 (18.9) | 1 (50) | 1.00 |
Sigmoid colon, n (%) | 2 (15.4) | 5 (41.7) | 1 (9.1) | 2 (22.2) | 1 (12.5) | 0 (0) | 0 (0) | 11 (20.8) | 1 (50) | 1.00 |
Rectum, n (%) | 4 (30.8) | 4 (33.3) | 6 (54.5) | 5 (55.6) | 3 (37.5) | 2 (66.7) | 0 (0) | 24 (45.3) | 0 (0) | 1.00 |
Serum laboratory test | ||||||||||
N/L ratio, mean ± SD | 14.9 ± 23.9 | 11.1 ± 25.9 | 6.8 ± 4.8 | 15.5 ± 30.7 | 6.9 ± 4.9 | 3.1 ± 2.4 | 3.6 | 11.1 ± 21.0 | 1.96 ± 1.5 | 0.13 |
Anti-CMV IgM | ||||||||||
Positive, n (%) | 0 (0) | 2 (16.7) | 1 (9.1) | 1 (11.1) | 0 (0) | 0 (0) | 0 (0) | 3 (5.7) | 0 (0) | 1.00 |
Negative, n (%) | 5 (38.5) | 7 (58.3) | 1 (9.1) | 2 (22.2) | 3 (37.5) | 1 (33.3) | 1 (100) | 20 (37.7) | 2 (100) | 0.16 |
Not available, n (%) | 8 (61.5) | 3 (25) | 9 (81.8) | 6 (66.7) | 5 (62.5) | 2 (66.7) | 0 (0) | 30 (56.6) | 0 (0) | 0.20 |
Anti-CMV IgG | ||||||||||
Positive, n (%) | 5 (38.5) | 6 (50) | 1 (9.1) | 2 (22.2) | 3 (37.5) | 1 (33.3) | 1 (100) | 19 (35.8) | 2 (100) | 0.14 |
Negative, n (%) | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 1.00 |
Not available | 8 (61.5) | 6 (50) | 10 (90.9) | 7 (77.8) | 5 (62.5) | 2 (66.7) | 0 (0) | 34 (64.2) | 0 (0) | 0.14 |
CMV PCR DNA amplification assays | ||||||||||
Positive, n (%) | 4 (30.8) | 5 (41.7) | 1 (9.1) | 0 (0) | 4 (50) | 0 (0) | 0 (0) | 14 (26.4) | 1 (50) | 0.47 |
Negative, n (%) | 2 (15.4) | 5 (41.7) | 0 (0) | 2 (22.2) | 3 (37.5) | 3 (100) | 1 (100) | 14 (26.4) | 1 (50) | 0.47 |
Not available, n (%) | 7 (53.8) | 2 (16.7) | 10 (90.9) | 7 (77.8) | 1 (12.5) | 0 (0) | 0 (0) | 25 (47.2) | 0 (0) | 0.49 |
Pathology | ||||||||||
Inclusion bodies, n (%) | 8 (61.5) | 5 (41.7) | 5 (45.5) | 6 (66.7) | 4 (50) | 1 (33.3) | 1 (100) | 30 (56.6) | 2 (100) | 0.50 |
CMV IHC staining, n (%) | 13 (100) | 12 (100) | 11 (100) | 9 (100) | 8 (100) | 3 (100) | 1 (100) | 53 (100) | 2 (100) | 1.00 |
Anti-viral therapy | ||||||||||
Ganciclovir, n (%) | 4 (30.8) | 4 (33.3) | 3 (27.3) | 2 (22.2) | 1 (12.5) | 2 (66.7) | 1 (100) | 17 (32.1) | 0 (0) | 1.00 |
Valganciclovir, n (%) | 4 (30.8) | 5 (41.7) | 2 (18.2) | 1 (11.1) | 4 (50) | 0 (0) | 0 (0) | 12 (22.6) | 0 (0) | 1.00 |
Ganciclovir plus Valganciclovir, n (%) | 2 (15.4) | 2 (16.7) | 2 (18.2) | 1 (11.1) | 1 (12.5) | 0 (0) | 0 (0) | 8 (15.1) | 2 (100) | 0.04 |
No treatment, n (%) | 3 (23.1) | 1 (8.3) | 4 (36.4) | 5 (55.6) | 2 (25) | 1 (33.3) | 0 (0) | 16 (30.2) | 0 (0) | 1.00 |
Complications | ||||||||||
Perforation, n (%) | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 2 (25) | 0 (0) | 0 (0) | 2 (3.8) | 0 (0) | 1.00 |
Category | Recipient No. 1 | Recipient No. 2 |
---|---|---|
Age (years) | 67 | 59 |
Gender | Male | Female |
Etiology of underlying liver disease | Non-B, non-C liver cirrhosis | Angiosarcoma, ruptured |
Clinical symptoms | Abdominal pain, diarrhea | Abdominal pain |
Lesion site | Transverse colon Descending colon | Ascending colon Transverse colon Sigmoid colon |
Colonoscopy findings | Segmental ulcer with intra-luminal narrowing | Patchy ulcers |
Serum laboratory test | ||
Recipient | ||
Anti-CMV IgM | ||
Pre-transplant, Index | Negative (0.08) | Negative (0.19) |
Post-transplant (at time of disease), Index | Negative (0.06) | Negative (0.34) |
Anti-CMV IgG | ||
Pre-transplant, AU/mL | Positive (2115.3) | Positive (73.6) |
Post-transplant (at time of disease), AU/mL | Positive (1199.3) | Positive (2280.9) |
CMV-DNA PCR (at time of disease) IU/mL | Not detectable | Positive (123) |
WBC (at time of disease) 1000/uL | 16.2 | 6.2 |
CRP (at time of disease) mg/L | 89.72 | 9.7 |
N/L ratio | 2.99 | 0.93 |
Donor | ||
Anti-CMV IgM (Index) | Negative (0.08) | Negative (0.06) |
Anti-CMV IgG (AU/mL) | Positive (615.3) | Negative (1.8) |
CMV-DNA PCR (IU/mL) | Not available | Not available |
Pathology | ||
Inclusion bodies | Present | Present |
CMV IHC staining | Positive | Positive |
Anti-viral medication | ||
Ganciclovir | 14 days | 12 days |
Valganciclovir | 90 days | 160 days |
Anti-viral medication duration (days) | 104 days | 172 days |
Time to disease | 10 years after LDLT | 2 months after LDLT |
Immunosuppressants use at time of CMV colitis | Mycophenolate mofetil 250mg Q12H PO, Tacrolimus 1mg QD PO | Mycophenolate mofetil 500 mg Q12H PO Prednisolone 5mg TID PO Tacrolimus 2mg QD PO |
Post-LDLT outcomes | ||
Allograft dysfunction | No | No |
Biliary tract stricture | No | Present |
Acute cellular rejection | Yes | No |
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content. |
© 2022 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Lin, S.-H.; Wu, K.-T.; Wang, C.-C.; Liu, T.-T.; Eng, H.-L.; Chiu, K.-W. Immunohistochemistry Staining-Proven Cytomegalovirus Colitis in Living Donor Liver Transplantation. Viruses 2023, 15, 115. https://doi.org/10.3390/v15010115
Lin S-H, Wu K-T, Wang C-C, Liu T-T, Eng H-L, Chiu K-W. Immunohistochemistry Staining-Proven Cytomegalovirus Colitis in Living Donor Liver Transplantation. Viruses. 2023; 15(1):115. https://doi.org/10.3390/v15010115
Chicago/Turabian StyleLin, Shu-Hsien, Kun-Ta Wu, Chih-Chi Wang, Ting-Ting Liu, Hock-Liew Eng, and King-Wah Chiu. 2023. "Immunohistochemistry Staining-Proven Cytomegalovirus Colitis in Living Donor Liver Transplantation" Viruses 15, no. 1: 115. https://doi.org/10.3390/v15010115
APA StyleLin, S.-H., Wu, K.-T., Wang, C.-C., Liu, T.-T., Eng, H.-L., & Chiu, K.-W. (2023). Immunohistochemistry Staining-Proven Cytomegalovirus Colitis in Living Donor Liver Transplantation. Viruses, 15(1), 115. https://doi.org/10.3390/v15010115