Management and outcomes after multiple corneal and solid organ transplantations from a donor infected with rabies virus.
BACKGROUND
This article describes multiple transmissions of rabies via transplanted solid organ from a single infected donor. The empirical Milwaukee treatment regimen was used in the recipients.


METHODS
Symptomatic patients were treated by deep sedation (ketamine, midazolam, and phenobarbital), ribavirin, interferon, and active and passive vaccination. Viral loads and antibodies were continuously monitored.


RESULTS
Recipients of both cornea and liver transplants developed no symptoms. The recipient of the liver transplant had been vaccinated approximately 20 years before transplantation. Two recipients of kidney and lung transplants developed rabies and died within days of symptomatic disease. Another kidney recipient was treated 7 weeks before he died. The cerebrospinal fluid viral load remained at constant low levels (<10,000 copies/mL) for approximately 5 weeks; it increased suddenly by almost 5 orders of magnitude thereafter. After death, no virus was found in peripheral compartments (nerve tissue, heart, liver, or the small intestine) in this patient, in contrast to in patients in the same cohort who died early.


CONCLUSIONS
Our report includes, to our knowledge, the longest documented treatment course of symptomatic rabies and the first time that the virus concentration was measured over time and in different body compartments. The postmortem virus concentration in the periphery was low, but there was no evidence of a reduction of virus in the brain.
Maier
T
T
Department of Internal Medicine and Nephrology, University of Marburg Medical Centre, Marburg, Germany.
Schwarting
A
A
Mauer
D
D
Ross
R S
RS
Martens
A
A
Kliem
V
V
Wahl
J
J
Panning
M
M
Baumgarte
S
S
Müller
T
T
Pfefferle
S
S
Ebel
H
H
Schmidt
J
J
Tenner-Racz
K
K
Racz
P
P
Schmid
M
M
Strüber
M
M
Wolters
B
B
Gotthardt
D
D
Bitz
F
F
Frisch
L
L
Pfeiffer
N
N
Fickenscher
H
H
Sauer
P
P
Rupprecht
C E
CE
Roggendorf
M
M
Haverich
A
A
Galle
P
P
Hoyer
J
J
Drosten
C
C
D000328:Adult; D000368:Aged; D000914:Antibodies, Viral / Q000008:administration & dosage* / Q000097:blood; D000998:Antiviral Agents / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D016377:Organ Transplantation / Q000009:adverse effects*; D011818:Rabies / Q000188:drug therapy*; D011819:Rabies Vaccines / Q000008:administration & dosage* / Q000276:immunology; D011820:Rabies virus / Q000302:isolation & purification*; D016896:Treatment Outcome; D019562:Viral Load
D000914:Antibodies, Viral; D000998:Antiviral Agents; D006993:Hypnotics and Sedatives; D011819:Rabies Vaccines