Cytomegalovirus disease in intestinal transplantation.

From May 1990 to July 1994,62 patients (22 isolated intestine [I], 29 liver and intestine [IlL], and 11 multivisceral [MV]) received 66 intestinal allografts at our center. There were 28 adults and 34 children. with ages ranging from 6 months to 58 years. Postoperative immunosuppression was with tacrolimus (FK 506), steroids. and in selected cases azathioprine (AZA). Donor and recipient procedures are described elsewhere.! Tissue sampling for CMV was performed when it was clinically indicated. Invasive CMV disease was diagnosed by histopathologic findings and/or by isolation of the virus from tissue specimens. Tissue invasion was determined by detection of typical CMV inclusion bodies along with predominant neutrophilic infiltration and/or unequivocal immunoperoxidase staining of the virus. Isolation of the virus was confirmed by either the shell vial technique or by standard culture. Forty-three of 62 recipients received gancyclovir prophylaxis (5 mg/kg) twice a day for 2 to 3 weeks in children. and for 3 weeks to 3 months in adults. followed by acyclovir for several months. CMV disease was treated by either gancyclovir (5 mg'kg twice a day). Foscarnet (tiO mg'kg three times a day), CMV immunoglobulin (100 mglkg every 2 weeks), or a combination of these agents. The elfect of CMV disease on patient and graft survival was studied. Chi·square. Kaplan-Meier. and log rank tests were used for statistical analysis. Statistical significance was achieved if the P value was less than .05.