1898. Clinical Characteristics of Patients With Solid-Organ Transplantation (SOT) and Norovirus (NV) Infections

Abstract

BackgroundNV infections in immunocompromised patients could cause chronic gastroenteritis (GE) with devastating consequences. A successful reduction of the medical immunsuppression in patients with NV GE and SOT have been reported repeatedly, but the optimal approach in these patients is less well defined.MethodsWe identified patients with PCR-confirmed NV GE and SOT from a laboratory database and patients with other underlying conditions from a clinical database. Clinical data were retrieved from pt files and by telephone interviews. The severity of GE was assessed by the Vesikari score (VS). Subgroups were dichotomised at their medians. Continuous variables were compared by Kruskal–Wallis test and time-dependant variables were compared by Kaplan–Meier analyses and log-rank test.ResultsOverall, 101 patients (age: 1–90 years, median 60) with SOT (36), hematopoietic stem cell transplantation (HSCT, 23), hematological malignancies (HM, 20), solid tumor (ST, 8), and other nonimmunocompromising conditions (14) were identified. Patients with SOT had received kidney (30), combined kidney/pancreas (4), liver/pancreas/stomach/small bowel (1), or liver/small bowel (1) transplantation.The median duration of symptoms was significantly longer in patients with SOT compared with those with other conditions (SOT 26, HSCT 12, HM 5, ST 4, other 3 days; Figure 1, P < 0.0001), but the disease severity (VS, 74 patients with sufficient data; Figure 2) was not significantly different across the risk groups.Age, time since transplantation, the use of calcineurin inhibitors vs. other drugs for immunosuppression, and comparison of kidney only vs. other organ transplantation were not predictive for a prolonged duration of NV GE in SOT patients. Interestingly, a reduction of the immunosuppression (IS) in SOT patients (dose reduction or drug termination) was associated with a prolonged duration of symptoms (median 47 vs. 14 days; Figure 3, P = 0.0007). ConclusionIn this series of patients, SOT was associated with a prolonged duration of NV GE. A reduction of the immunosuppression was associated with a prolonged disease duration in SOT patients. It remains unclear whether this observation is due to a selection bias, or aggravation of symptoms were caused by immune reconstitution with reduced immunosuppressive therapy.Disclosures All authors: No reported disclosures.