LOCALIZATION OF CYTOMEGALOVIRUS ANTIGENS IN LIVER ALLOGRAFTS OVER TIME

被引:21
作者
THEISE, ND [1 ]
CONN, M [1 ]
THUNG, SN [1 ]
机构
[1] UNIV PENN,PRESBYTERIAN MED CTR,DEPT MED,PHILADELPHIA,PA 19104
关键词
CYTOMEGALOVIRUS; LIVER TRANSPLANT; IMMUNOPEROXIDASE;
D O I
10.1016/0046-8177(93)90069-S
中图分类号
R36 [病理学];
学科分类号
100104 ;
摘要
Cytomegalovirus (CMV) hepatitis is a common and serious complication of orthotopic liver transplantation. Immunohistochemical studies are the most sensitive methods of diagnosis. We compared immunoperoxidase staining with monoclonal antibodies to CMV immediate early and early antigens with routine hematoxylin-eosin stain. Eleven of 140 liver allograft recipients at our institution had CMV hepatitis identified by hematoxylin-eosin stain on biopsy specimens. We stained serial sections of all previous biopsy specimens and one post-ganciclovir biopsy specimen (when available) from each of these patients. One or both monoclonal antibodies confirmed the original hematoxylin-eosin stain diagnoses. Cytomegalovirus was detected in earlier, hematoxylin-eosin stain-negative biopsy specimens in seven of 11 patients. Detection of immediate early antigen often preceded that of early antigen. Earlier biopsy specimens demonstrated less positive staining, which become more extensive closer in time to the hematoxylin-eosin stainpositive biopsy specimens. Sinusoidal cells became positive earlier than hepatocytes. In one patient occult CMV antigens persisted in biopsy specimens following ganciclovir treatment. We conclude that (1) immunohistochemical staining for CMV antigens can result in earlier detection of viral infection, which may lead to earlier, more effective treatment; (2) CMV infection and antigen expression is focal, requiring extensive examination for diagnosis; (3) extent of occult infection may indicate the extent of active infection in the organ as a whole; (4) most CMV hepatitis begins with infection of sinusoidal lining cells as a result of hematogenous spread from within the allograft or from systemic viremia; and (5) posttreatment biopsy specimens may be more sensitive than resolution of serum liver enzyme abnormalities in evaluating the success of ganciclovir therapy. © 1993.
引用
收藏
页码:103 / 108
页数:6
相关论文
共 15 条
[1]  
BACH N, 1989, GASTROENTEROLOGY, V96, P573
[2]   OCCURRENCE OF CYTOMEGALO-VIRUS HEPATITIS IN LIVER-TRANSPLANT PATIENTS [J].
BRONSTHER, O ;
MAKOWKA, L ;
JAFFE, R ;
DEMETRIS, AJ ;
BREINIG, MK ;
HO, M ;
ESQUIVEL, CO ;
GORDON, RD ;
IWATSUKI, S ;
TZAKIS, A ;
MARSH, JW ;
MAZZAFERRO, V ;
VANTHIEL, D ;
STARZL, TE .
JOURNAL OF MEDICAL VIROLOGY, 1988, 24 (04) :423-434
[3]   MOLECULAR-BIOLOGY AND IMMUNOLOGY OF CYTOMEGALOVIRUS [J].
GRIFFITHS, PD ;
GRUNDY, JE .
BIOCHEMICAL JOURNAL, 1987, 241 (02) :313-324
[5]   DIFFERENCES IN CELL TYPE-SPECIFIC BLOCKS TO IMMEDIATE EARLY GENE-EXPRESSION AND DNA-REPLICATION OF HUMAN, SIMIAN AND MURINE CYTOMEGALO-VIRUS [J].
LAFEMINA, RL ;
HAYWARD, GS .
JOURNAL OF GENERAL VIROLOGY, 1988, 69 :355-374
[6]  
LAI YS, 1989, ARCH PATHOL LAB MED, V113, P134
[7]   RAPID IDENTIFICATION OF CYTOMEGALO-VIRUS IN LIVER ALLOGRAFT BIOPSIES BY INSITU HYBRIDIZATION [J].
MASIH, AS ;
LINDER, J ;
SHAW, BW ;
WOOD, RP ;
DONOVAN, JP ;
WHITE, R ;
MARKIN, RS .
AMERICAN JOURNAL OF SURGICAL PATHOLOGY, 1988, 12 (05) :362-367
[8]  
MAZERON MC, 1984, DEV BIOLOGICALS, V57, P287
[9]   INSITU HYBRIDIZATION IN FORMALIN FIXED, PARAFFIN WAX EMBEDDED LIVER SPECIMENS - METHOD FOR DETECTING HUMAN AND VIRAL-DNA USING BIOTINYLATED PROBES [J].
NAOUMOV, NV ;
ALEXANDER, GJM ;
EDDLESTON, ALWF ;
WILLIAMS, R .
JOURNAL OF CLINICAL PATHOLOGY, 1988, 41 (07) :793-798
[10]   DETECTION OF CYTOMEGALO-VIRUS BY INSITU HYBRIDIZATION AND IMMUNOHISTOCHEMISTRY USING NEW MONOCLONAL-ANTIBODY CCH2 - A COMPARISON OF METHODS [J].
NIEDOBITEK, G ;
FINN, T ;
HERBST, H ;
GERDES, J ;
GRILLNER, L ;
LANDQVIST, MA ;
WIRGART, BZ ;
STEIN, H .
JOURNAL OF CLINICAL PATHOLOGY, 1988, 41 (09) :1005-1009