Rolak Stacey, Di Bartolomeo Sarah, Jorgenson Margaret R, Saddler Christopher M, Singh Tripti, Astor Brad C, Parajuli Sandesh
Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
Pharmacy Department, UW Health, Madison, Wisconsin.
Transpl Infect Dis. 2019 Apr;21(2):e13053. doi: 10.1111/tid.13053. Epub 2019 Feb 11.
Recently, Norovirus has been recognized as an important cause of diarrheal infection in kidney transplant recipients (KTRs). We assessed the risk factors and outcomes of Norovirus diarrheal infections (NVDI) and Clostridioides difficile infection (CDI) on graft and patient survival following kidney transplant (KT). We examined KTRs transplanted at our center between 1994 and 2014, and compared those who suffered from NVDI and CDI with patients who did not develop either infection. Each patient with NVDI or CDI was matched with five controls based on time from transplant. Of the 4941 KTs performed during the study period, there were 2112 evaluable cases: 66 NVDI cases, 286 CDI cases, and 1760 controls. Median uncensored graft survival following infection was 497.5 days for the NVDI group, 440 days for the CDI group, and 1271 days for controls. Those with CDI had significantly inferior graft survival than controls (HR 2.41; CI 2.01, 2.90; P < 0.001), and those with NVDI had a 23% lower risk of graft survival than controls (HR 1.23; CI 1.0, 1.52; P = 0.054). Diarrheal infection after KT is associated with reduced long-term graft survival.
最近，诺如病毒已被确认为肾移植受者（KTRs）腹泻感染的重要病因。我们评估了肾移植（KT）后诺如病毒腹泻感染（NVDI）和艰难梭菌感染（CDI）对移植物和患者生存的风险因素及结局。我们研究了1994年至2014年在我们中心接受移植的KTRs，并将患有NVDI和CDI的患者与未发生任何感染的患者进行比较。根据移植后的时间，将每例NVDI或CDI患者与五名对照进行匹配。在研究期间进行的4941例KT中，有2112例可评估病例：66例NVDI病例、286例CDI病例和1760例对照。感染后未审查的移植物中位生存期，NVDI组为497.5天，CDI组为440天，对照组为1271天。患有CDI的患者移植物生存率明显低于对照组（HR 2.41；CI 2.01，2.90；P < 0.001），患有NVDI的患者移植物生存风险比对照组低23%（HR 1.23；CI 1.0，1.52；P = 0.054）。肾移植后的腹泻感染与长期移植物生存率降低有关。
