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Abstract: SA-PO380

Norovirus Gastroenteritis in Pediatric Kidney Transplant Recipients: A Pediatric Nephrology Research Consortium Study

Session Information

  • Pediatric Nephrology - III
    November 04, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Pediatric Nephrology

  • 1900 Pediatric Nephrology


  • Kizilbash, Sarah J., University of Minnesota Twin Cities School of Medicine, Minneapolis, Minnesota, United States
  • Jiang, Ziou, University of Wisconsin-Madison, Madison, Wisconsin, United States
  • Engen, Rachel M., University of Minnesota Twin Cities School of Medicine, Minneapolis, Minnesota, United States

Norovirus can cause debilitating diarrhea in transplant recipients. Herein, we describe the clinical course and complications of norovirus infection in children with a kidney transplant.


Four transplant centers participated in this study. We included kidney transplant recipients who developed norovirus infection (confirmed by stool polymerase chain reaction or viral culture) between 1/1/2013 and 12/1/2019. Study variables are summarized as median and proportions. The estimated glomerular filtration rate (eGFR) was determined using the modified Schwartz equation. Acute kidney injury (AKI) was defined based on a change in eGFR per the pRIFLE criteria.


Our cohort included 40 patients, 33 (82.5%) requiring hospitalization. The median age at transplant was 5.4 years (IQR:2.2, 1.2). Thirty-one patients (77.5%) were white, and 26 (65.0%) were male. The median time to diarrhea onset after transplant was 1.9 years (IQR:0.8, 3.8). The median diarrhea duration was 16 days (IQR:6.0,41.5), and that of hospitalization was 3 days (IQR: 2.0,8.0). During the norovirus infection, 17.5% developed neutropenia, 15% had a urinary tract infection, 17.5% had BK DNAemia, and 20% had EBV DNAemia. Furthermore, 52.5% developed AKI. We found no sustained decline in the median eGFR 12 months after diarrhea resolution (Table 1). Of the patients in the cohort, 2 lost their graft 6.8 and 30.0 months after the onset of diarrhea.


Norovirus can cause prolonged diarrhea in pediatric kidney transplant recipients complicated by AKI, neutropenia, and opportunistic infections. We found no sustained decline in eGFR over a 12-month follow-up. Multicenter, randomized controlled trials are needed to determine the most appropriate management strategy in children.

Table 1: Baseline Characteristics