Immunohistochemistry Staining-Proven Cytomegalovirus Colitis in Living Donor Liver Transplantation

Shu-Hsien Lin; Kun-Ta Wu; Chih-Chi Wang; Ting-Ting Liu; Hock-Liew Eng; King-Wah Chiu

doi:10.3390/v15010115

Immunohistochemistry Staining-Proven Cytomegalovirus Colitis in Living Donor Liver Transplantation

Viruses. 2022 Dec 30;15(1):115. doi: 10.3390/v15010115.

Authors

Shu-Hsien Lin^{1

2}, Kun-Ta Wu³, Chih-Chi Wang^{2

4

5}, Ting-Ting Liu⁶, Hock-Liew Eng^{5

6}, King-Wah Chiu^{1

2

5}

Affiliations

¹ Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Taiwan 123 Ta-Pei Road, Niao-Sung District, Kaohsiung 833, Taiwan.
² Liver Transplantation Program, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan.
³ Division of General Surgery, Department of Surgery, E-Da Hospital, Kaohsiung 833, Taiwan.
⁴ Division of General Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan.
⁵ College of Medicine, Chang Gung University, Taoyuan 333, Taiwan.
⁶ Department of Pathology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan.

Abstract

Background and Aims: Cytomegalovirus (CMV) infection is a common occurrence in liver transplantation (LT) even in an era of preventive strategies. However, the diagnosis of CMV colitis remains challenging. This study aimed to focus on the clinical significance of endoscopic biopsy-proven CMV colitis in patients following living donor liver transplantation (LDLT). Methods: From January 2007 to December 2021, a total of 55 CMV colitis cases were retrospectively enrolled and divided into a non-LDLT group in 53 and an LDLT group in 2 cases. Clinical demographics, diagnostic measurement, histopathology, and anti-viral therapy were investigated. Results: There were 1630 cases undergoing LDLT in the period 2007-2021, with only 2 recipients being confirmed to have CMV colitis in 2021 (2/114, 1-year incidence: 1.75%). Comparisons between the 53 non-LDLT cases and 2 LDLT cases are as follows: Serum anti-CMV immunoglobulin M (IgM) was shown to be positive (n = 3, 5.5% vs. n = 0, p = 1.0) and negative (n = 20, 37.7% vs. n = 2, 100%, p = 0.16); anti-CMV immunoglobulin G (IgG) was positive (n = 19, 35.8% vs. n = 2, 100%, p = 0.14) and none were negative; CMV DNAemia was shown to be detectable (n = 14, 26.4% vs. n = 1, 50%, p = 0.47) and undetectable (n = 14, 26.4% vs. n = 1, 50%, p = 0.47). Among the two recipients with CMV colitis, one had CMV DNAemia and the other had no CMV DNAemia upon the development of symptoms; negative anti-CMV-IgM and positive anti-CMV-IgG were observed both pre-transplant and post-transplant; finally, CMV colitis was documented based on the presence of inclusion bodies and positive immunohistochemistry (IHC) staining in histology. Conclusion: Patients with immunocompromised status, in particular organ transplantation, may have positive serum anti-CMV IgM/IgG antibodies both before and after transplantation. This study emphasized the fact that endoscopic biopsy with IHC staining may be a more powerful tool for making an accurate diagnosis of CMV colitis in the setting of living donor liver transplantation.

Keywords: cytomegalovirus colitis; immunoglobulin; inclusion body; living donor liver transplantation.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Antibodies, Viral
Colitis* / diagnosis
Cytomegalovirus
Cytomegalovirus Infections*
Humans
Immunoglobulin M
Immunohistochemistry
Liver Transplantation* / adverse effects
Living Donors
Retrospective Studies
Staining and Labeling

Substances

Antibodies, Viral
Immunoglobulin M

Grants and funding

This research was supported by grants from the Chang Gung Memorial Hospital of Taiwan (grant number CMRPG8L0701 and CMRPG8M0421).