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Norovirus Infection in Transplant Recipients

  • Intra-abdominal Infections, Hepatitis, and Gastroenteritis (T Steiner, Section Editor)
  • Published:
Current Infectious Disease Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Norovirus is a leading cause of diarrhea in transplant recipients. Norovirus can cause a severe acute syndrome in this patient population. Transplant recipients can also develop a chronic diarrheal syndrome with associated frailty, prolonged viral shedding, hospitalizations, and rejection, with associated mortality. Despite the significant burden of disease and improved diagnostics, there are no specific treatments to target norovirus. We aim to review the virology, epidemiology, diagnosis, clinical presentation, management, and prevention of norovirus.

Recent Findings

A recent retrospective observational study included nine solid organ transplant recipients (5 kidneys, 2 kidney-pancreas, 1 heart, and 1 lung) with chronic norovirus (median duration of diarrhea 12 weeks). Six of these nine patients demonstrated resolution of diarrhea at hospital discharge after oral human immune globulin. A recent phase II randomized controlled trial including solid organ transplant and bone marrow transplant recipients with norovirus compared nitazoxanide with placebo. Nitazoxanide did not demonstrate improved time to resolution of symptoms or duration of viral shedding but may have resulted in transient symptom improvement.

Summary

Norovirus causes significant morbidity and mortality in transplant recipients. Although there are no approved treatment options, there are multiple strategies available, including supportive care, reduction in immunosuppression, intravenous immunoglobulin (IVIG), oral human immune globulin (OHIG), vitamin A, ribavirin, nitazoxanide, and the use of mammalian target of rapamycin (mTOR) inhibitors. Randomized controlled trials are needed to better study these strategies and prevention through the development of a universally available vaccine.

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Data Availability

No datasets were generated or analysed during the current study.

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Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Authors and Affiliations

  1. NYU Grossman School of Medicine, New York, NY, USA

    Matthew Ringer

  2. NYU Langone Transplant Institute, New York, NY, USA

    Matthew Ringer

  3. Yale School of Medicine, Section of Infectious Disease, New Haven, CT, USA

    Maricar Malinis

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M.R. and M.M. made substantial contributions to the conception of the manuscript, drafted the manuscript, revised the manuscript, reviewed the manuscript and approved the version to be published.

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Correspondence to Matthew Ringer or Maricar Malinis.

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Ringer, M., Malinis, M. Norovirus Infection in Transplant Recipients. Curr Infect Dis Rep (2024). https://doi.org/10.1007/s11908-024-00842-y

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