How would you manage persistent Norovirus diarrheal infections in a kidney transplant patient that are not responding to a decrease in the patient’s maintenance immunosuppressive regimen?

This is a difficult situation and does not have a strong evidence based response. First, I would really make sure they are not on mycophenolate as this is really the main problem with chronic Norovirus for most patients. Next, I would see if there are any available clinical trials that the patient m...

Enteral immunoglobulin given post-pyloric has helped.

We have used it in the following refractory situations with success:

• chronic diarrhea
• not responding to safe lowering of IS- mainly stopping MMF and lowering CNIs
• severe persistent diarrhea not responding to the above and associated with either ...

I was not aware of the use of enteral IG for chronic norovirus infection. Management practically by multiple experts is useful.