Norovirus Infection in Renal Transplant Recipients – Clinical Severity and Genotype Identification

J. Roodnat,¹ Y. Rakké,¹ J. Beek van,³ M. Koopmans,² M. Betjes,¹ W. Weimar,¹ M. Beersma.²

¹Internal Medicine, Erasmus Medical Centre, Rotterdam, Netherlands
²Department of Viroscience, Erasmus Medical Centre, Rotterdam, Netherlands
³National Institute for Public Health and the Environment, Bilthoven, Netherlands.

Meeting: 2015 American Transplant Congress

Abstract number: 337

Keywords: Adenoviruses, Infection, Kidney transplantation, Renal dysfunction

Session Information

Session Name: Concurrent Session: Viral Infections (CMV, HBV, HCV, HIV, Norovirus)

Session Type: Concurrent Session

Date: Monday, May 4, 2015

Session Time: 4:00pm-5:30pm

Presentation Time: 5:00pm-5:12pm

Location: Room 121-AB

Introduction: Norovirus (NoV) is increasingly recognized as causative agent of gastro-enteritis in renal transplant recipients.

Methods: We performed a retrospective study (2003-2012) to investigate the clinical significance and viral genotype of Norovirus (NoV) infections in renal transplant recipients. The clinical significance was defined in a 6-point score, allocating one point for each: diarrhoea, vomiting, nausea, IV fluid administration, changes in immunosuppressive agents, and antibiotic treatment. NoV genotypes distribution in part of the cohort (54/79) was compared to part of a control group of non renal transplant patients (67/177) and to the Dutch population (RIVM).

Results: There had been 332 NoV positive samples in our hospital in the period studied. 141/332 positive samples were from 79 renal transplant patients. Mean age was 46.3±19.6 years, with male/female ratio 47/32, and mean time after transplantation of 3.6±4.7 years. Mean increase in serum creatinine was 91±102 umol/l with a range of 0-439 umol/l. In most patients serum creatinine returned to baseline. 57 patients required hospitalization for their infection. 48.1% of the patients scored 4 or more points and where considered to have severe NoV infection. 191/332 NoV positive stools were in 177 non renal transplant patients. 101/177 (57%) NoV positive patients turned out to be immunocompromised: other organ transplant (heart, liver, lung, bone marrow), malignancy, HIV, systemic diseases. 34/177 (19%) other diseases. 20/177 (11%) no severe somatic disease and 21/177 (12%) unknown. In renal transplant patients stool samples 74% tested genotype GII.P4 compared to 63% of controls. The GII.4 variant trends in the hospital reflect that in the general Dutch population. Of all NoV positive patients 180/256 (70%) was immunocompromised.

Conclusion. Renal transplant recipients with NoV infection may develop severe disease that may lead to (reversible) graft dysfunction. NoVgenotype in these patients is similar to genotypes in controls and in the Dutch population. In our hospital population 70% of NoV positive patients were immunocompromised.

To cite this abstract in AMA style:

Roodnat J, Rakké Y, van JBeek, Koopmans M, Betjes M, Weimar W, Beersma M. Norovirus Infection in Renal Transplant Recipients – Clinical Severity and Genotype Identification [abstract]. Am J Transplant. 2015; 15 (suppl 3). https://atcmeetingabstracts.com/abstract/norovirus-infection-in-renal-transplant-recipients-clinical-severity-and-genotype-identification/. Accessed June 23, 2025.

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