Noroviral diarrhea in solid organ transplant recipients: An analysis of interventions and outcomes. Issue 2 (2nd December 2022)

• Record Type: Journal Article
• Authors: Nair, Sashi N.; Bhaskaran, Archana; Chandorkar, Aditya; Fontana, Lauren; Obeid, Karam M.
• Is Part Of: Clinical transplantation. Volume 37:Issue 2(2023)
• Page Start: n/a
• Page End: n/a
• Publication Date: 2022-12-02
• Subjects: diarrhea -- immunoglobulins -- immunosuppression therapy -- intravenous -- norovirus -- organ transplantation; Transplantation of organs, tissues, etc -- Periodicals; 617.95
• DOI: 10.1111/ctr.14855
• Languages: English
• ISSNs: 0902-0063

Abstract

Abstract: 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.