POS-774 Role of Noro virus infection in post renal transplant persistent diarrhea

ABSTRACT

Introduction: Diarrhea is common gastrointestinal problem in kidney transplant recipients. Numerous cases of post-transplant diarrhea in the past have been ascribed solely to the toxicity of immunosuppressive drugs, leading to diagnostic misconceptions. Noro Virus, one of the common cause of acute diarrhea in adult is emerging as important cause of persistent diarrhea in solid organ transplant recipients.Here, we are presenting our experience with chronic Noro virus infection in renal transplant recipients. Aim of the study was to determine the clinical significance of Noro virus infection in renal transplant recipients with persistent diarrhea. Methods: Between December’19 and November’20, renal transplant recipients presenting with persistent diarrhoea (≥3 stools/day for ≥14 consecutive days) were evaluated in a step wise manner including stool Noro virus RTPCR and were followed for 12 months. Stool specimen were collected in container (Cary-Blair Transport Media) and stored or at -94°F (-70°C). This tests were performed using TaqMan real-time reverse transcription-PCR assay ( Fast-track diagnostic). The detection and typing of Norovirus by conserved nucleotide sequences of the ORF1-ORF2 junction region of the Norovirus genome. Patients were followed up clinically. Repeat RTPCR Noro virus in stool were evaluated on follow up at 3, 6, 9 and 12 months. Because of COVID 19 pandemic, we were not able to collect repeat stool RTPCR samples for Noro virus on follow up in all patients. Telephonic follow up was obtained in patients who had not come for follow up during study period. Results: 29 out of 39 patients were positive for Noro virus RTPCR. Median time of presentation following transplant was 59 months (range 12 to 143 months). Median duration of diarrhoea was 69 days (range 14 to 365 days). Median weight loss on presentation was 6.4 kg (range 1.7 to 17.3 kg). Out of 20 patients who were on Tac/MMF/Prednisolone at presentation, MMF was withheld in 11;switched to Azathioprine in 3, switched to Everolimus in 3 and 3 were continued on same medications. Out of 7 patients receiving Tac/Azathioprine/Prednisolone, Azathiporine dose reduced in all;3 were switched to cyclosporine from tacrolimus. 2 patients receiving Tacrolimus & prednisolone only, were switched to cyclosporine. Diarrhoea responded in all. Out of 13 patients presenting with renal dysfunction;6 had worsening of renal function whereas 8 had steady or better renal function at 6 months. 15 patients gained weight at 6 months;8 had persistent weight loss. Conclusions: Noro virus infection is important cause of persistent diarrhea in renal transplant recipients. It is associated with significant weight loss, renal dysfunction and prolonged asymptomatic viral shedding. We should look for etiologies other than immunesuppression drugs as cause of persistent diarrhea. No conflict of interest