title: Clinical outcome of norovirus infection in renal transplant patients.
abstract: Transplant patients are at increased risk for developing severe norovirus (NoV) infections with secondary complications such as rejection episodes and acute transplant failure. This single-center retrospective study included all kidney transplant patients tested positive for NoV RNA between January 2007 and December 2011. Data were compared to a control group of 528 kidney transplant patients without NoV infection. Sixty-five kidney transplant patients were recorded NoV RNA positive. Of these, 26 patients (40%) presented with acute transplant failure (AKI). In 43 patients (66.2%), dose reduction in immunosuppression was performed, and of 22 patients receiving tacrolimus, four patients (18.2%) showed toxic trough levels above 15 ng/mL at time of diagnosis. In three patients (4.6%), indicated therapeutic procedures had to be postponed due to prolonged severe diarrhea. Ten patients (15.4%) developed chronic NoV infection. One-year patient and graft survival in NoV patients and controls was 92.3% and 96.4%, respectively (n.s.). Compared to controls, eGFR was already significantly lower before NoV infection and loss of eGFR relative to baseline over 12 and 36 months was significantly higher in NoV-infected patients. In particular, patients initially presenting with AKI experienced a long-term loss of transplant function. Risk factors for NoV infection were immunosuppression containing steroids and antirejection therapy.
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Charité Campus Mitte, Berlin, Germany. Susanne.brakemeier@charite.de.
authors.forename: Susanne
authors.initials: S
authors.lastname: Brakemeier
authors.affiliation: Department of Hematology, Charite Campus Mitte, Berlin, Germany.
authors.forename: Styliani I
authors.initials: SI
authors.lastname: Taxeidi
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Charité Campus Mitte, Berlin, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Dürr
authors.affiliation: Institute of Medical Virology, Charité University Medicine and Labor Berlin Charité-Vivantes GmbH, Berlin, Germany.
authors.forename: Jörg
authors.initials: J
authors.lastname: Hofmann
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Charité Campus Mitte, Berlin, Germany.
authors.forename: Danilo
authors.initials: D
authors.lastname: Schmidt
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Charité Campus Mitte, Berlin, Germany.
authors.forename: Friederike
authors.initials: F
authors.lastname: Bachmann
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Charité Campus Mitte, Berlin, Germany.
authors.forename: Jens
authors.initials: J
authors.lastname: Gaedeke
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Charité Campus Mitte, Berlin, Germany.
authors.forename: Klemens
authors.initials: K
authors.lastname: Budde
mesh_terms: D000328:Adult; D000368:Aged; D017250:Caliciviridae Infections / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology / Q000628:therapy; D016022:Case-Control Studies; D002908:Chronic Disease; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006084:Graft Rejection / Q000453:epidemiology / Q000821:virology; D006085:Graft Survival; D006801:Humans; D053208:Kaplan-Meier Estimate; D016030:Kidney Transplantation / Q000401:mortality; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology / Q000628:therapy; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors
keywords: acute transplant failure; kidney transplantation; norovirus infection; single-center retrospective study