Outcomes of Norovirus diarrheal infections and<i> Clostridioides difficile </i>infections in kidney transplant recipients: A single‐center retrospective study

Rolak, Stacey; Bartolomeo, Sarah Di; Jorgenson, Margaret R.; Saddler, Christopher M; Singh, Tripti; Astor, Brad C.; Parajuli, Sandesh

doi:10.1111/tid.13053

Cited by 6 publications

(4 citation statements)

References 26 publications

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“…34 Among KTx recipients, NoV infection has previously been shown to be associated with reduced graft survival and a persistent reduction in eGFR. 29,35,36 To our knowledge, no other published study has discriminated between patients with acute or chronic NoV infection with regard to renal graft function. However, because of the retrospective and observational nature of this and other studies, the reasons for inferior graft survival remain limited to hypotheses.…”

Section: Discussionmentioning

confidence: 99%

Norovirus Infections in Kidney Transplant Recipients

et al. 2021

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Background. Norovirus (NoV) infection frequently progresses to chronic disease after kidney transplant (KTx). This study aims to assess potential risk factors helping to determine patients at risk of chronic NoV infection and to analyze the effect of NoV on allograft outcome. Additionally, we assessed the effectiveness of intravenous immunoglobulin (IVIg) therapy for chronic NoV infection. Methods. The study enrolled 60 KTx patients requiring hospitalization because of NoV infection. Clinical parameters, severity of NoV infection and potential risk factors were evaluated. Outcome parameters were clinical symptoms, rehospitalizations, persistent shedding of virus, and effects on allograft function. Results. Patients were divided into 2 groups: 29 had acute NoV infection only, 31 progressed to chronic NoV infection. Chronic NoV infection was defined as a recurrence of clinical symptoms plus redetection of NoV in stool. Lymphocyte-depleting induction therapy and diabetes mellitus were independent risk factors for chronic infection. For patients with chronic NoV infection, length of stay in hospital was significantly prolonged (P = 0.024). Allograft function remained impaired in the chronic NoV group 6 and 12 mo after initial admission. IVIg was administered to 18 patients with chronic NoV infection. No further clinical symptoms of NoV infection occurred in 13 (72%) of these patients. However, NoV was still detectable in stool specimens from 10 (77%) of these patients. Conclusions. Chronic NoV infection is associated with reduced allograft function. Administration of IVIg to patients with chronic NoV infection seems beneficial in achieving freedom from clinical symptoms, despite limited effects on shedding of virus.

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Section: Discussionmentioning

confidence: 99%

Norovirus Infections in Kidney Transplant Recipients

et al. 2021

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“…In contrast, NVD in SOT recipients may be prolonged, lasting several months, and in one case longer than 7 years 5 . The annual incidence of NVD in the SOT population has been estimated to be between 4% and 7% and as high as 13.5% 5–7 . However, other factors may contribute to persistent diarrheal symptoms, including mycophenolate (MPA) induced diarrhea and co‐infections, which occur in up to 19% of NVD in SOT recipients 8 .…”

Section: Introductionmentioning

confidence: 99%

“… 5 The annual incidence of NVD in the SOT population has been estimated to be between 4% and 7% and as high as 13.5%. 5 , 6 , 7 However, other factors may contribute to persistent diarrheal symptoms, including mycophenolate (MPA) induced diarrhea and co‐infections, which occur in up to 19% of NVD in SOT recipients. 8 The optimal management has not been defined despite multiple reports describing the frequency and severity of the long‐term impacts of NVD in SOT recipients.…”

Section: Introductionmentioning

confidence: 99%

Noroviral diarrhea in solid organ transplant recipients: An analysis of interventions and outcomes

Nair

Bhaskaran

Chandorkar

et al. 2022

Clinical Transplantation

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Introduction Noroviral infection can lead to chronic diarrhea in solid organ transplant (SOT) recipients with significant morbidity and mortality. Existing literature has described a wide spectrum of illness and has not come to a consensus on the optimal management of this condition. Methods We undertook a retrospective review of all adult SOT recipients between 1/1/2018 and 12/31/2020 who were diagnosed with their first episode of noroviral diarrhea (NVD). Demographic, clinical interventions, and outcomes within 6 months of diagnosis were recorded. Patients’ outcomes were classified as either resolved, improved or persistent at 6 months. Results Seventy‐nine SOT recipients were included. Thirty‐eight patients (48%) had chronic diarrhea at baseline (CDB). Thirty‐two patients (40%) received nitazoxanide, 28 patients (35%) had their immunosuppression adjusted and seven patients (9%) received intravenous immunoglobulin. Diarrhea improved or resolved in 68 patients (85%). Improvement or resolution of diarrhea was observed in 98% of those who did not have history of chronic diarrhea versus 74% in those who did (p = .002). NVD improved in all 12 patients who had mycophenolate discontinued, although this was not statistically significant (p = .131). Conclusion CDB was associated with worse outcomes regardless of intervention. A low threshold to test for NVD in SOT recipients with chronic diarrhea is prudent to prevent delayed diagnosis.

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“…Norovirus infection has been associated with AKI (23%-46%), persistent decreased eGFR, and shortened graft survival in adult kidney transplant recipients [4,14,29,30], but there are no published data on outcomes in pediatric kidney recipients. We found a high incidence of AKI, slightly higher than that reported in adult cohorts.…”

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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Outcomes of Norovirus diarrheal infections and Clostridioides difficile infections in kidney transplant recipients: A single‐center retrospective study

Cited by 6 publications

References 26 publications

Norovirus Infections in Kidney Transplant Recipients

Norovirus Infections in Kidney Transplant Recipients

Noroviral diarrhea in solid organ transplant recipients: An analysis of interventions and outcomes

Norovirus Management and Outcomes in a Multicenter Pediatric Kidney Transplant Population

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