Persistent Norovirus infection in a young patient with renal transplant: The challenging cost of immunosuppression and the negative impact on patient’s quality of life

Saad, Eltaib; Abdalla, M. Sebawe; Ahmed, Abdul‐Rahman; Faris, Mohammed Elamin; Mustafa, Abdurrahman; Abdalla, Monzer; Stake, Jonathan; Friedman, Harvey M.

doi:10.1016/j.idcr.2023.e01783

Cited by 1 publication

(1 citation statement)

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“…In adult renal transplant recipients, the incidence of chronic diarrhea among hospitalized patients is reportedly as high as 94% [5]. In our cohort, the incidence of hospitalization was high at over 82%, whereas the incidence of chronic diarrhea was slightly lower at 30%; however, this remains a significant burden due to the risks of intravascular volume depletion, tacrolimus toxicity, nutrient deficiencies, electrolyte disorders, and significantly lower quality of life in patients with recurrent hospitalizations and chronic diarrhea [19][20][21][22][23]. The American Society of Transplantation currently recommends testing for norovirus in any solid organ transplant recipient with diarrhea of greater than 14 days duration (strong, moderate) [13].…”

Section: Discussionmentioning

confidence: 99%

Norovirus Management and Outcomes in a Multicenter Pediatric Kidney Transplant Population

Engen,

Keyser,

Jiang

et al. 2024

Pediatric Transplantation

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BackgroundNorovirus is the most common cause of viral gastroenteritis. Studies in adult kidney recipients have documented significant morbidity associated with norovirus infection, but there are few studies in pediatric recipients.MethodsMulticenter retrospective cohort study of pediatric kidney transplant recipients with norovirus, confirmed by stool PCR, between January 1, 2008, and December 31, 2018. Outcomes of interest included duration of diarrhea, incidence of chronic diarrhea, management strategies, and graft function.ResultsForty pediatric kidney transplant recipients from four centers were identified for inclusion. Median age at transplant was 5.4 years (IQR 2.2–11.2 years), and median time post‐transplant was 1.9 years (IQR 0.8–3.8 years). Median diarrheal duration was 16 days (IQR 6.0–41.5 days); 15 patients (43%) had acute diarrhea, 8 (23%) had persistent, and 12 (30%) had chronic diarrhea. Twenty‐one (53%) patients developed acute kidney injury. Thirty‐five (88%) patients required supplemental fluids, 8 (20%) patients underwent immunosuppression reduction for a median of 22 days, 5 (13%) were treated with nitazoxanide, and 5 (13%) received oral immunoglobulin. Acute rejection was diagnosed in 3 (8%) patients within 6 months of norovirus diagnosis. We observed no sustained decline in eGFR at 12 months after diarrhea resolution (median eGFR difference: 2.8 mL/min/1.73 m2 [IQR: −17.1, 7.4]). Of the patients in the cohort, two lost their graft at 6.8 and 30.0 months after the onset of diarrhea.ConclusionNorovirus is associated with significant morbidity in pediatric kidney transplant recipients. Various treatment interventions are being employed for norovirus infection. Larger studies, both observational and interventional, are needed to determine the optimal treatment.

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