(HealthDay News) – Eighteen months after receiving a kidney transplant, a recipient died from acute progressive encephalitis caused by rabies infection that had been undiagnosed in the donor, according to research published in the July 24/31 issue of the Journal of the American Medical Association.

Neil M. Vora, MD, of the U.S. Centers for Disease Control and Prevention in Atlanta, and colleagues investigated whether a kidney recipient who died from encephalitis caused by rabies 18 months after transplantation was infected by tissue from the donor. Other recipients of organs from the same donor were evaluated for rabies infection.

The researchers found, in retrospect, that the clinical presentation for the donor was consistent with rabies infection. Rabies virus antigen was found in brain tissue collected from the donor at autopsy. Genetic sequencing of samples from the deceased donor and the deceased kidney recipient revealed a nearly identical gene for raccoon rabies virus variant and confirmed the organ transplant as the route of transmission. The three other organ recipients were asymptomatic; neutralizing antibodies to rabies virus were detected in their serum after they received post-exposure prophylaxis.

“Despite the immunosuppressed state of all four organ recipients, the affected patient remained asymptomatic for 18 months after transplantation, and the three other patients did not develop rabies,” writes the author of an accompanying editorial. “Raising awareness of the risk of using donors with undiagnosed CNS infection is the best way to reduce the occurrence of these transmissions.”

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