Clinical management and humoral immune responses to rabies post-exposure prophylaxis among three patients who received solid organs from a donor with rabies

N. M. Vora*, L. A. Orciari, M. Niezgoda, G. Selvaggi, V. Stosor, G. M. Lyon, R. M. Wallace, J. Gabel, D. R. Stanek, P. Jenkins, M. Shiferaw, P. Yager, F. Jackson, C. A. Hanlon, I. Damon, J. D. Blanton, S. Recuenco, R. Franka

*Corresponding author for this work

Research output: Contribution to journalArticle

11 Scopus citations

Abstract

Background: The rabies virus causes a fatal encephalitis and can be transmitted through organ transplantation. In 2013, a man developed rabies 18 months after receiving a kidney from a donor with rabies, who was not known to have been infected when the organs were procured. Three additional persons who received organs from the same donor (liver, kidney, heart), all of whom were not vaccinated for rabies before transplantation, received rabies post-exposure prophylaxis (PEP) with rabies immune globulin and 5 doses of rabies vaccine as soon as the diagnosis of rabies was made in the donor (18 months after their transplant surgeries). We describe their clinical management. Methods: As the 3 recipients were all on immunosuppressive medications, post-vaccination serologic testing was performed using the rapid fluorescent focus inhibition test to measure rabies virus neutralizing antibodies (RVNAs). An acceptable antibody response to administration of rabies vaccine was defined as detection of RVNAs at a concentration ≥0.1 IU/mL from a serum specimen collected ≥7 days after the fifth vaccine dose. Results: All 3 recipients demonstrated an acceptable antibody response despite their immunosuppressed states. More than 36 months have passed since their transplant surgeries, and all 3 recipients have no evidence of rabies. Conclusions: The survival of 3 previously unvaccinated recipients of solid organs from a donor with rabies is unexpected. Although the precise factors that led to their survival remain unclear, our data suggest that PEP can possibly enhance transplant safety in settings in which donors are retrospectively diagnosed with rabies.

Original languageEnglish (US)
Pages (from-to)389-395
Number of pages7
JournalTransplant Infectious Disease
Volume17
Issue number3
DOIs
StatePublished - Jun 1 2015

Keywords

  • Post-exposure prophylaxis
  • Rabies
  • Solid organ transplantation

ASJC Scopus subject areas

  • Infectious Diseases
  • Transplantation

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    Vora, N. M., Orciari, L. A., Niezgoda, M., Selvaggi, G., Stosor, V., Lyon, G. M., Wallace, R. M., Gabel, J., Stanek, D. R., Jenkins, P., Shiferaw, M., Yager, P., Jackson, F., Hanlon, C. A., Damon, I., Blanton, J. D., Recuenco, S., & Franka, R. (2015). Clinical management and humoral immune responses to rabies post-exposure prophylaxis among three patients who received solid organs from a donor with rabies. Transplant Infectious Disease, 17(3), 389-395. https://doi.org/10.1111/tid.12393