Background and Aims: There have been 10 outbreaks of rabies following solid organ or corneal transplantation. In December 2014, 4 organ recipients died in 2 countries.

Methods: Chart review and verbal autopsy. Serum and CSF detection of rabies-specific antibodies by IFA and RFFIT. Results: A 28 year old donor presented with chest infection, cardiac arrest, and seizure. CT of the head was unremarkable. CSF culture was negative. A kidney recipient developed encephalitis within 2 months of transplantation and died. The second kidney recipient developed symptoms a week later and died. The family of the donor confirmed that he was bitten by a domestic dog in India 2 months prior to his death and did not receive prophylaxis; the dog died. The heart recipient had died after cardiac arrest with prodromal neuropsychiatric symptoms. The liver recipient developed drooling and hydrophobia and died after 34 days. Ante mortem brain biopsy showed Negri bodies. Rabies RNA was detected in brain and saliva. Rabies antibodies were detected in serum and CSF. Rabies was confirmed in the donor by RT-PCR of explanted cornea. Deceased kidney recipients had no rabies antibodies. Corneas were explanted from 2 recipients who received prophylaxis; they remain well. . Conclusions: Avoidance of transmission of rare pathogens requires wide bandwidth diagnostics and rapid-cycle surveillance within transplantation networks.

CITATION INFORMATION: Elsiesy H, Hussain I, Abaalkhail F, Al-Hamoudi W, Elbeshbeshy H, Al Sebayel M, Broering D, Elgohary A, Al Fawaz S, Althawadi S, Alotaibi J, AlHindi H, Nair P, Al- Otaibi T, Nampoory N, Orciar L, Velasco-Villa A, Yager P, Smith T, Carson W, Niezgoda M, Wadhwa A, Edgar Condori R, Li Y, Franka R, Halim M, Willoughby R. Donor Transmited Rabies Outbreak Involving Four Transplant Recepients in Kuwait and Saudi Arabia. Am J Transplant. 2016;16 (suppl 3).

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