1. CLINICAL COURSE AND MANAGEMENT OF NOROVIRUS INFECTION FOLLOWING SMALL BOWEL TRANSPLANTATION IN CHILDREN K. Nikaki¹, M. Patel², J. Hartley¹, L. Ibarra³, K. Guthrie 4, G. Gupte¹ ¹Paediatric Liver Unit (including small bowel transplantation),²Microbiology Department, ³Pharmacy Department, 4 Dietetic Department, Birmingham Children’s Hospital, UK Contact e-mail: girish.gupte@bch.nhs.uk INTRODUCTION METHODS RESULTS CONCLUSIONS Norovirus infection can be life- threatening in immunocompromised patients following intestinal transplantation (ITx) [1,2]. No treatment is currently available. Retrospective study of 85 paediatric ITx recipients at Birmingham Children’s Hospital (1993 - 2014). Definitions: Norovirus infection: first positive faecal qualitative PCR Acute gastroenteritis: 100% increase in stool frequency or stoma losses +/- vomiting or dehydration. 20 (23.5%) patients developed Noroviral gastroenteritis (12F:8M). Mean time interval of ITx to Noroviral infection: 2.15 yrs (2 months- 15 yrs). Days of Hospitalisation: 5-114 days. Similar immunosuppression regimes were used for all intestinal transplant recipients 8 (40%) patients had significant change in immunosuppression within the last 3 months prior to Noroviral infection due to:  Rejection (n=6*) * Combination of factors  PTLD (n=1)  GvHD (n=2*)  Autoimmune haemolytic anaemia (n=2*) 7 (35%) patients needed PN support. 14 (70%) received oral human immunoglobulins (OHIG):  Time interval from ITx to Noroviral gastroenteritis: 1.1 yrs (vs 3.1 yrs in non OHIG patients)  Hospitalisation time: 39.4 days (vs 29.4 days in non OHIG patients) Histopathological changes of norovirus infection in graft biopsies were similar to changes seen in rejection The course of illness was complicated by acute rejection in 6 (30%) patients Norovirus is a significant pathogen in ITx patients and heightened vigilance for viral infections is required these patients. Differentiation of Noroviral infection from rejection is crucial. Oral immunoglobulins can be used empirically but more targeted treatments are needed. 466 AIM Report on prevalence, clinical course and management of Norovirus infection from a national paediatric ITx centre. DISCUSSION On average, children treated with OHIG were younger, with a shorter time interval between Noroviral gastroenteritis and ITx. OHIG reportedly [3] shortens the period of diarrhoea but we did not observe a shortened hospitalisation time. The histopathological appearances of Norovirus can mimic rejection [2] and it is important to correlate clinically as they can precede each other. * 3 out of the 4 patients who needed PN / iv fluids at discharge post Norovirus gastroenteritis were on full enteral feeds on the latest follow-up. References: 1.Bok, K. and K.Y. Green, Norovirus Gastroenteritis in Immunocompromised Patients. New England Journal of Medicine, 2012. 367(22): p. 2126-2132. 2.Kaufman, S.S., et al., Characteristics of Human Calicivirus Enteritis in Intestinal Transplant Recipients. Journal of Pediatric Gastroenterology and Nutrition, 2005. 40(3): p. 328-333. 3.Florescu, D.F., et al., Is there a role for oral human immunoglobulin in the treatment for norovirus enteritis in immunocompromised patients? Pediatr Transplant, 2011. 15(7): p. 718-21