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Norovirus Management and Outcomes in a Multicenter Pediatric Kidney Transplant Population
Rachel M Engen1, Michelle Keyser2, Ziou Jiang3
1University of Wisconsin Madison, Madison, Wisconsin, USA.
Pediatric Transplantation
|July 12, 2024
Summary
Norovirus infection causes significant illness in pediatric kidney transplant patients, leading to prolonged diarrhea and acute kidney injury. While graft function generally recovers, further research is needed to optimize treatment strategies.
Area of Science:
- Pediatric Nephrology
- Transplant Immunology
- Infectious Diseases
Background:
- Norovirus is a leading cause of viral gastroenteritis.
- While norovirus complications in adult kidney recipients are known, data on pediatric recipients is limited.
Purpose of the Study:
- To investigate the clinical outcomes and management of norovirus infection in pediatric kidney transplant recipients.
Main Methods:
- A multicenter retrospective cohort study analyzed pediatric kidney transplant recipients diagnosed with norovirus via stool PCR between 2008 and 2018.
- Outcomes included diarrhea duration, chronic diarrhea incidence, management strategies, and graft function.
Main Results:
- Of 40 patients, 43% had acute diarrhea, 23% persistent, and 30% chronic. 53% developed acute kidney injury.
- Most patients required fluid support; interventions included immunosuppression reduction, nitazoxanide, and oral immunoglobulin.
- 3 patients experienced acute rejection; no sustained decline in eGFR was observed at 12 months post-resolution. Two patients lost their graft.
Conclusions:
- Norovirus infection poses a significant morbidity risk for pediatric kidney transplant recipients.
- Current management involves various interventions, but optimal treatment requires further investigation.
- Larger observational and interventional studies are necessary to establish best practices for norovirus management in this population.
