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Multicenter Study
. 2024 Jun;26(3):e14270.
doi: 10.1111/tid.14270. Epub 2024 Mar 25.

Presentation, management, and outcomes of norovirus in adult and pediatric solid organ and hematopoietic stem cell transplant recipients: A multicenter, retrospective study

Michelle Callegari  1 , Lara A Danziger-Isakov  2 , Anne Rose  2 , Daniel Kaul  3 , Kelly Shaffer  3 , Pearlie P Chong  4 , Diana Florescu  5 , Kaci German  5 , Robin Avery  6 , M Hong Nguyen  7 , Brett Wildfeuer  7 , Marian G Michaels  8 , Michael Green  8 , Kexin Guo  9 , Lihui Zhao  10 , Amna Daud  1 , Michael G Ison  11
Affiliations
Multicenter Study

Presentation, management, and outcomes of norovirus in adult and pediatric solid organ and hematopoietic stem cell transplant recipients: A multicenter, retrospective study

Michelle Callegari et al. Transpl Infect Dis. 2024 Jun.

Abstract

Background: Norovirus (NoV) can cause chronic relapsing and remitting diarrhea in immunocompromised patients. Few multicenter studies have described the clinical course, outcomes, and complications of chronic NoV in transplant recipients.

Methods: A multicenter retrospective study of adult and pediatric SOT and HSCT recipients diagnosed with NoV between November 1, 2017, and February 28, 2021. Data were obtained from electronic medical records (EMR) and entered into a central REDCap database. Descriptive statistics were calculated.

Results: A total of 280 NoV+ patients were identified across eight sites. The majority were adults (74.1%) and SOT recipients (91.4%). Initial diagnosis of NoV occurred a median of 36 months post-Tx (IQR [15.0, 90.0]). Most NoV cases had >3 diarrheal episodes daily (66.0%), nausea and vomiting (60.1%). Duration of diarrhea varied greatly (median = 10 days, mean = 85.9 days, range (1, 2100)). 71.3% were hospitalized. Adjustment of immunosuppression, including reduction and discontinuation of mToR inhibitor, CNI, and/or MMF, was the most common management intervention for NoV. Other therapies resulted only in temporary improvement. Four patients died within 30 days and three others died by 180 days postdiagnosis. Clinically significant renal dysfunction was observed in 12.5% by 30 days and 21.4% by 180 days post-NoV diagnosis.

Conclusion: In HSCT and SOT patients, NoV frequently resulted in severe symptoms, prolonged diarrhea (30% persistent with diarrhea for >30 days), and clinically significant renal dysfunction (up to 21% of patients). Utilized therapies did not reliably result in the resolution of infection demonstrating the need for more effective treatment.

Keywords: HSCT; diarrhea; norovirus; renal insufficiency; transplant.

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Figures

FIGURE 1.
FIGURE 1.
Kaplan-Meier Survival Estimate for Transplant Patients Diagnosed with NoV
FIGURE 2.
FIGURE 2.
Kaplan-Meier Time-to-Event Estimate for Graft Loss Occurrence
FIGURE 3.
FIGURE 3.
Kaplan-Meier Time-to-Event Estimate for Graft Rejection Occurrence
See this image and copyright information in PMC

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