Severity and outcome of the norovirus infection in children after intestinal transplantation.

In immunocompromised patients, the NoV infection is prolonged and severe. We retrospectively studied the severity of the NoV infection in children after an ITx, the treatment, and the long-term evolution. Norovirus PCR in stools was positive for 19 children in 21 separate episodes. The infection was symptomatic in 18 cases. At diagnosis, the median weight loss was 5% (0-11) and the creatinine clearance was 75 mL/min/1.73 m ² (19-142). On 14 digestive biopsies, the pathological findings were non-specific with a constant mononuclear infiltration, showing signs of rejection in one case. Fifteen children in 17 cases were hospitalized for a median duration of 41 days (0-119) with IV infusions for 33 days (0-120). The viral shedding lasted 78 days (20-360). Nine children with severe or prolonged diarrhea received intravenous IGs and four of them additional NTZ. On follow-up, five other children developed a rejection 12 months (1-33) after NoV infection. Four uncontrolled rejections led to graft removal. Children mostly needed hospital admission and IV rehydration, but the symptoms upon presentation were moderate. Symptoms and shedding durations are prolonged as expected. The treatment efficacy cannot be assessed. The rejection induction by the NoV cannot be excluded.
(© 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)