NV infections in immunocompromised pts could cause chronic gastroenteritis (GE) with devastating consequences. A successful reduction of the medical immunsuppression in pts with NV GE and SOT have been reported repeatedly, but the optimal approach in these pts is less well defined.
We identified pts with PCR-confirmed NV GE and SOT from a laboratory database and pts with other underlying conditions from a clinical database. Clinical data were retrieved from pt files and by telephone interviews. The severity of GE was assessed by the Vesikari score (VS). Subgroups were dichotomised at their medians. Continuous variables were compared by Kruskal-Wallis test and time-dependant variables were compared by Kaplan-Meier analyses and Log-rank test.
Overall, 101 pts (age: 1-90 years, median 60) with SOT (36), hematopoietic stem cell transplantation (HSCT, 23), hematological malignancies (HM, 20), solid tumor (ST, 8), and other non-immunocompromising conditions (14) were identified. Pts with SOT had received kidney (30), combined kidney/pancreas (4), liver/pancreas/stomach/small bowel (1), or liver/small bowel (1) transplantation.
The median duration of symptoms was significantly longer in pts with SOT compared to those with other conditions (SOT 26, HSCT 12, HM 5, ST 4, other 3 days; Figure 1, p<0.0001), but the disease severity (VS, 74 pts with sufficient data; Figure 2) was not significantly different across the risk groups.
Age, time since transplantation, the use of calcineurin inhibitors versus other drugs for immunosuppression, and comparison of kidney only versus other organ transplantation were not predictive for a prolonged duration of NV GE in SOT pts. Interestingly, a reduction of the immunosuppression (IS) in SOT pts (dose reduction or drug termination) was associated with a prolonged duration of symptoms (median 47 versus 14 days; Figure 3, p = 0.0007).
In this series of pts, SOT was associated with a prolonged duration of NV GE. A reduction of the immunosuppression was associated with a prolonged disease duration in SOT pts. It remains unclear whether this observation is due to a selection bias, or aggravation of symptoms were caused by immune reconstitution with reduced immunosuppressive therapy.
M. Tölle, None
P. Reinke, None
S. Brakemeier, None
S. Schwartz, None