Management of Norovirus Infection in Solid Organ Transplant Recipients: A Scoping Review

Norovirus infection causes significant morbidity in solid organ transplant (SOT) recipients, yet few treatments are available, and evidence for efficacy is sparse. In this scoping review, we identify and evaluate potential interventions for managing norovirus infections in SOT recipients.

We searched electronic databases from inception to July 6, 2025. Eligible studies were analyzed for participants' characteristics, intervention types, and reported outcomes.

After screening 245 abstracts, 58 studies were included (1 randomized controlled trial, 27 cohort studies, 5 case series and 25 case reports), mainly from the United States. Transplant types included kidney (n = 36), liver (n = 12), cardiac (n = 12), pulmonary (n = 7), pancreas (n = 6), small bowel (n = 7), and multiorgan (n = 13) transplants. The most frequently reported primary outcome was resolution of gastrointestinal (GI) symptoms. Interventions were diverse: immunosuppression modification (n = 14), nitazoxanide (n = 6), IVIG (n = 3), oral immunoglobulin (n = 10), combination of these (n = 19), fecal transplant (n = 2), supportive management (n = 4), and others not classified (n = 5). Limited quality evidence for the resolution of gastrointestinal symptoms was reported for immunosuppression modification (n = 7/14), nitazoxanide (n = 4/6), IVIG (n = 2/3), oral immunoglobulin alone (n = 10/10), fecal transplant (n = 2/2), supportive treatment (n = 4/4), and a combination of treatments (n = 10/19). A lack of clinical improvement was described in 13 of 58 studies.

A wide range of interventions has been used to manage norovirus infections in SOT recipients; however, the evidence is limited to observational studies, and the findings are uncertain. High-quality randomized controlled trials are needed to establish treatment efficacy and safety.