Abstract: SA-PO1150
An Unexpected Cause of Prolonged Post-Transplant Diarrhea: Sapovirus Enteritis
Session Information
- Transplantation: Clinical - Infectious Diseases
October 24, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 2002 Transplantation: Clinical
Authors
- Dunn, Jacob M., University of Utah Health, Salt Lake City, Utah, United States
- Bjordahl, Terrence S., University of Utah Health, Salt Lake City, Utah, United States
Introduction
Sapovirus is a well-established cause of acute enteritis. The immunocompetent host usually clears the infection in less than a week. However, in immunocompromised hosts, such as kidney transplant recipients, Sapovirus can take significantly longer to clear, with reports demonstrating chronic viral shedding. Treatment in this population remains challenging, balancing the need for continued immunosuppression with infection clearance.
Case Description
A 58-year-old female underwent three kidney transplants secondary to membranous nephropathy, most recently in 2021. At the time of transplantation, she had no significant gastrointestinal symptoms, and weighed 183 lbs. In the months following transplantation, she developed chronic diarrhea. An extensive workup, including esophagogastroduodenoscopy and colonoscopy were non-revealing. Her symptoms continued, with a weight decline to 117 lbs. by early 2026 despite interventions. She then presented with pneumonia and septic shock at our institution. While admitted, due to continued chronic diarrhea, stool PCR was collected which demonstrated Sapovirus positive status. After discharge, she remained PCR positive on repeat testing for the following six weeks with no change in symptoms. Due to suspected chronic Sapovirus infection, her immunosuppressive regimen consisting of belatacept, tacrolimus, myfortic, and prednisone was decreased to belatacept, reduced dose myfortic, and prednisone, in addition to nitazoxanide. Patient reported significant improvement in her symptoms, without evidence of graft rejection.
Discussion
Among kidney transplant patients, the workup for chronic diarrhea is broad and must consider many etiologies. Sapovirus, while recognized in acute enteritis, is not typically thought of as a chronic etiology, and therefore less commonly included in chronic enteritis workup. However, reports are demonstrating chronic viral shedding in individuals. Unlike other well-defined etiologies of chronic infection in transplant recipients, Sapovirus does not have a definitive antiviral agent, relying on supportive care. While de-escalation of immunosuppressive therapy represents a primary supportive strategy, it must be balanced against the potential for precipitating graft rejection. Additionally, evidence suggests that although symptoms will likely improve with immunosuppressive de-escalation, incomplete viral clearance with symptom recurrence is likely.