多中心儿科肾移植人群中诺如病毒的管理和结局。

Norovirus Management and Outcomes in a Multicenter Pediatric Kidney Transplant Population.

机构信息

University of Wisconsin Madison, Madison, Wisconsin, USA.

University of California San Diego, San Diego, California, USA.

出版信息

Pediatr Transplant. 2024 Aug;28(5):e14821. doi: 10.1111/petr.14821.

DOI:10.1111/petr.14821

PMID:38992876

Abstract

BACKGROUND

Norovirus is the most common cause of viral gastroenteritis. Studies in adult kidney recipients have documented significant morbidity associated with norovirus infection, but there are few studies in pediatric recipients.

METHODS

Multicenter retrospective cohort study of pediatric kidney transplant recipients with norovirus, confirmed by stool PCR, between January 1, 2008, and December 31, 2018. Outcomes of interest included duration of diarrhea, incidence of chronic diarrhea, management strategies, and graft function.

RESULTS

Forty pediatric kidney transplant recipients from four centers were identified for inclusion. Median age at transplant was 5.4 years (IQR 2.2-11.2 years), and median time post-transplant was 1.9 years (IQR 0.8-3.8 years). Median diarrheal duration was 16 days (IQR 6.0-41.5 days); 15 patients (43%) had acute diarrhea, 8 (23%) had persistent, and 12 (30%) had chronic diarrhea. Twenty-one (53%) patients developed acute kidney injury. Thirty-five (88%) patients required supplemental fluids, 8 (20%) patients underwent immunosuppression reduction for a median of 22 days, 5 (13%) were treated with nitazoxanide, and 5 (13%) received oral immunoglobulin. Acute rejection was diagnosed in 3 (8%) patients within 6 months of norovirus diagnosis. We observed no sustained decline in eGFR at 12 months after diarrhea resolution (median eGFR difference: 2.8 mL/min/1.73 m [IQR: -17.1, 7.4]). Of the patients in the cohort, two lost their graft at 6.8 and 30.0 months after the onset of diarrhea.

CONCLUSION

Norovirus is associated with significant morbidity in pediatric kidney transplant recipients. Various treatment interventions are being employed for norovirus infection. Larger studies, both observational and interventional, are needed to determine the optimal treatment.

摘要

背景

诺如病毒是病毒性肠胃炎最常见的病因。成人肾移植受者的研究已证实诺如病毒感染与显著发病率相关，但儿童肾移植受者的研究较少。

方法

这是一项多中心回顾性队列研究，纳入了 2008 年 1 月 1 日至 2018 年 12 月 31 日期间，经粪便 PCR 检测确诊的 40 例患有诺如病毒的儿科肾移植受者。研究的主要结局包括腹泻持续时间、慢性腹泻发生率、治疗策略和移植物功能。

结果

从四个中心共纳入 40 例儿科肾移植受者。移植时的中位年龄为 5.4 岁（IQR 2.2-11.2 岁），移植后中位时间为 1.9 年（IQR 0.8-3.8 年）。腹泻持续时间的中位数为 16 天（IQR 6.0-41.5 天）；15 例（43%）为急性腹泻，8 例（23%）为持续性腹泻，12 例（30%）为慢性腹泻。21 例（53%）患者发生急性肾损伤。35 例（88%）患者需要补充液体，8 例（20%）患者接受免疫抑制药物剂量减少，中位时间为 22 天，5 例（13%）接受硝唑尼特治疗，5 例（13%）接受口服免疫球蛋白治疗。在诺如病毒诊断后 6 个月内，有 3 例（8%）患者诊断为急性排斥反应。腹泻缓解后 12 个月，我们观察到 eGFR 没有持续下降（中位数 eGFR 差值：2.8 mL/min/1.73 m [IQR：-17.1，7.4]）。在该队列中，有 2 例患者分别在腹泻发作后 6.8 个月和 30.0 个月时失去了移植物。