*Purpose: Norovirus may result in significant morbidity in solid organ transplant (SOT) recipients. There is limited evidence for therapeutics beyond supportive care for the management of norovirus infections. Data on additional therapeutics such as nitazoxanide and immunoglobulin (IgG) is limited. We sought to analyze the characteristics, therapeutic strategies and outcomes of norovirus infection in SOT recipients at our institution.

*Methods: All adult SOT recipients diagnosed with a first norovirus infection between 1/1/18 and 12/31/20 were identified using our local SOT database. Patients were excluded if they were coinfected with other diarrheal pathogens, expired, or enrolled in hospice within 1 week of diagnosis. Clinical and laboratory data from the 6-month period after diagnosis was collected. Recovery was defined as resolution or improvement of diarrhea within 6 months. Correlative statistics were performed using SPSS version 16.

*Results: One hundred and thirteen patients tested positive for norovirus during the study period, 79 were included. Our population demographics are included in Table 1. Sixty-eight patients (86%) recovered and 11 patients had persistent diarrhea without improvement. Two patients died from unrelated causes, and 29 patients (38%) had norovirus-related hospitalizations. Thirty-two patients (40%) received at least 3 days of nitazoxanide with a median duration of 14 days (3-44 days). Recovery was achieved in 84% vs. 87% with and without the use of nitazoxanide respectively (p=0.72), in 86% with or without mycophenolate reduction (p=0.96), in 86% with or without any reduction to immunosuppressive therapy (p=0.95), and 71% vs. 89% with and without IgG respectively (p=0.24). Similarly, there were no significant differences between rates of recovery among various SOT types.

*Conclusions: We demonstrate that norovirus is associated with high rates of morbidity in this population. While nitazoxanide is frequently used to treat norovirus infection, there was no association with recovery in our population. There remain no proven effective intervention strategies.

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