Acute Rejection Grading

Cytomegalovirus (CMV) Infection

CMV infection occurs in approximately one-third of the patients receiving small bowel allografts(1). Some patients present with multiple episodes of CMV infection in spite of treatment. The histological diagnosis of CMV infection is usually straight-forward. CMV inclusions can be found in endothelial, stromal, and less often, epithelial cells, although their numbers varied considerably among biopsy specimens. CMV infection can be associated with either predominantly neutrophilic infiltration or predominantly mononuclear infiltration. The inclusions can also be found in mucosal erosion or ulcer base without active inflammation . Immunostaining for CMV antigens is useful to confirm the diagnosis.

1. Abu-Elmagd K, Reyes J, Todo S, Rao A, Lee R, Irish W, Furukawa H, Bueno J, McMichael J, Fawzy AT, Murase N, Demetris J, Rakela J, Fung JJ, Starzl TE. Clinical intestinal transplantation: New Perspectives and immunologic considerations. J Am Coll Surg 1998; 186:512-527.

2. Lee RG, Nakamura K, Tsamandas AC, Abu-Elmagd K, Furukawa H, Hutson WR, Reyes J, Tabasco-Minguillan JS, Todo S, Demetris AJ. Pathology of human intestinal transplantation. Gastroenterology 1996;110:1820-1834.

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Last Modified: Thu Jun 18 10:14:08 EDT 2009