Florescu Diana F, Sonderup Jessica L, Grant Wendy, Chong Pearlie P, van Duin David, Kalil Andre C
Transplant Infectious Diseases Program, University of Nebraska Medical Center, Omaha, NE, USA.
Transplant Surgery Program, University of Nebraska Medical Center, Omaha, NE, USA.
Transpl Infect Dis. 2017 Jun;19(3). doi: 10.1111/tid.12692. Epub 2017 Apr 27.
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).
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.
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).
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.
与天然肠道（来自其他同种异体移植受者，nITR）相比，关于肠道同种异体移植（来自肠道和多脏器移植受者，ITR）中诺如病毒胃肠炎（NVE）的临床表现和病程尚无数据。
这是一项对2010年1月1日至2014年4月1日期间两个中心患有NVE的实体器官移植受者进行的回顾性研究。采用卡方检验、t检验、线性和逻辑回归分析来比较ITR与nITR患者的NVE情况。
将ITR患者（45例）与nITR患者（107例）进行比较。ITR患者更年轻（优势比[OR]=0.90；P<0.0001），接受抗淋巴细胞诱导治疗的可能性更小（OR=0.15；P<0.0001），从移植到发生NVE的时间更短（OR=0.99；P=0.008）。发病时，ITR患者恶心（OR=0.11；P<0.0001）或呕吐（OR=0.36；P=0.01）的频率更低，白细胞计数更高（OR=1.09；P=0.001），肾小球滤过率更高（OR=1.02；P<0.0001）。ITR患者接受抗动力药物治疗的可能性更小（OR=9.6；P<0.0001）。ITR患者更有可能需要更长时间的静脉输液（OR=1.18；P<0.0001）；发生NVE复发（OR=4.25；P<0.0001）；住院时间更长（OR=1.07；P<0.0001）；发生急性排斥反应（OR=5.1；P=0.006）；总体生存率更低（OR=0.28；P=0.006）。
与nITR相比，患有NVE的ITR患者明显更年轻，发病时恶心和呕吐症状更少，接受抗动力药物治疗更少，需要更多静脉输液，住院时间更长。ITR患者中NVE导致生存率降低有一定趋势。
