title: Clinical presentation and outcomes of norovirus infection in intestinal allograft compared to native intestine.
abstract: BACKGROUND
  No data are available on clinical manifestations and course of norovirus gastroenteritis (NVE) in intestinal allograft (from intestinal and multivisceral transplant recipients, ITR) compared to native intestine (from other allograft recipients, nITR).
  
  
  METHODS
  This was a retrospective study of solid organ transplant recipients with NVE at two centers from January 1, 2010 to April 1, 2014. Chi-square, t-test, linear and logistic regression analyses were done to compare NVE in ITR vs nITR patients.
  
  
  RESULTS
  The ITR (45 patients) were compared to nITR (107 patients). ITR were younger (odds ratio [OR]=0.90; P<.0001), less likely to receive anti-lymphocyte induction therapy (OR=0.15; P<.0001), and had shorter time from transplant to NVE (OR=0.99; P=.008). On presentation ITR had less frequent nausea (OR=0.11; P<.0001) or vomiting (OR=0.36; P=.01), higher white blood cell count (OR=1.09; P=.001), and higher glomerular filtration rate (OR=1.02; P<.0001). ITR were less likely to receive anti-motility agents (OR=9.6; P<.0001). ITR were more likely to stay longer on intravenous (IV) fluids (OR=1.18; P<.0001); have recurrent NVE (OR=4.25; P<.0001); have longer hospital stay (OR=1.07; P<.0001); develop acute rejection (OR=5.1; P=.006); and have lower overall survival (OR=0.28; P=.006).
  
  
  CONCLUSIONS
  Compared to nITR, the ITR with NVE were significantly younger, had less nausea and vomiting at presentation, received less anti-motility agents, required more IV fluids, and had longer hospital stay. A trend was seen for lower survival with NVE in ITR.
authors.affiliation: Transplant Infectious Diseases Program, University of Nebraska Medical Center, Omaha, NE, USA.|Transplant Surgery Program, University of Nebraska Medical Center, Omaha, NE, USA.
authors.forename: Diana F
authors.initials: DF
authors.lastname: Florescu
authors.affiliation: Internal Medicine Department, University of Nebraska Medical Center, Omaha, NE, USA.
authors.forename: Jessica L
authors.initials: JL
authors.lastname: Sonderup
authors.affiliation: Transplant Surgery Program, University of Nebraska Medical Center, Omaha, NE, USA.
authors.forename: Wendy
authors.initials: W
authors.lastname: Grant
authors.affiliation: Division of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
authors.forename: Pearlie P
authors.initials: PP
authors.lastname: Chong
authors.affiliation: Division of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
authors.forename: David
authors.identifier: http://orcid.org/0000-0003-4784-3227
authors.initials: D
authors.lastname: van Duin
authors.affiliation: Transplant Infectious Diseases Program, University of Nebraska Medical Center, Omaha, NE, USA.
authors.forename: Andre C
authors.initials: AC
authors.lastname: Kalil
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D064591:Allografts / Q000473:pathology / Q000821:virology*; D000961:Antilymphocyte Serum / Q000627:therapeutic use; D001706:Biopsy; D017250:Caliciviridae Infections / Q000150:complications / Q000188:drug therapy* / Q000401:mortality / Q000821:virology; D002648:Child; D002675:Child, Preschool; D005759:Gastroenteritis / Q000150:complications / Q000188:drug therapy* / Q000401:mortality / Q000821:virology; D005919:Glomerular Filtration Rate; D006084:Graft Rejection / Q000453:epidemiology / Q000517:prevention & control / Q000821:virology; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D060828:Induction Chemotherapy / Q000009:adverse effects / Q000379:methods; D007223:Infant; D007231:Infant, Newborn; D007422:Intestines / Q000473:pathology / Q000637:transplantation* / Q000821:virology; D007902:Length of Stay / Q000706:statistics & numerical data; D018655:Lymphocyte Count; D008875:Middle Aged; D009325:Nausea / Q000453:epidemiology / Q000209:etiology; D029322:Norovirus / Q000302:isolation & purification*; D016377:Organ Transplantation / Q000009:adverse effects*; D012008:Recurrence; D012189:Retrospective Studies; D016019:Survival Analysis; D014184:Transplantation, Homologous / Q000009:adverse effects; D014839:Vomiting / Q000453:epidemiology / Q000209:etiology; D055815:Young Adult
chemical_list: D000961:Antilymphocyte Serum; D007166:Immunosuppressive Agents
keywords: enteritis; graft intestine; intestinal transplant; native intestine; norovirus