Raccoon rabies virus variant transmission through solid organ transplantation

Area of Science:

• Infectious Diseases
• Virology
• Transplant Surgery

Background:

• Rabies virus causes fatal encephalitis and can be transmitted through organ transplantation.
• A kidney recipient died of rabies 18 months post-transplant, with no reported animal exposure.

Observation:

• The organ donor's symptoms were retrospectively consistent with rabies.
• Rabies virus antigen was detected in the donor's archived brain tissue.
• Phylogenetic analysis confirmed the rabies viruses in the donor and recipient were nearly identical.

Findings:

• Organ transplantation was confirmed as the transmission route for rabies virus.
• Three other organ recipients remained asymptomatic and developed rabies virus neutralizing antibodies after postexposure prophylaxis.
• The deceased recipient had a prolonged incubation period, and other recipients survived without pre-transplant vaccination.

Implications:

• Rabies should be considered in unexplained acute progressive encephalitis, particularly in potential organ donors.
• Standardized screening of organ donors for infectious encephalitis is crucial.
• Careful evaluation of risks and benefits is necessary for recipients of organs from donors with potential infectious etiologies.