In March 2025, American media reported a rare case of rabies infection from a kidney transplant. A detailed description of the case and the results of the epidemiological investigation have now been published in the US Centers for Disease Control and Prevention (CDC) journal Morbidity and Mortality Weekly Report (MMWR) .
Despite screening during organ and tissue transplantation, there is a small but non-zero risk of transmitting various infections or, in rarer cases, malignancies from the donor to the recipient. One such infection is rabies, a zoonosis caused by the RNA-containing neurotropic virus Lyssavirus rabies of the Rhabdoviridae family, which has a near-100% fatality rate without post-exposure prophylaxis. Transmission from deceased donors is extremely rare—according to the CDC, four such cases have been reported in the United States since 1978, resulting in 13 infected recipients (six of whom received prophylactic treatment and survived, the other seven did not and died). Similar cases have also been reported from China.
As reported by Rebecca Earnest of the CDC and her colleagues, on January 27, 2025, the organization received notification of a possible rabies infection from a kidney transplant and launched an investigation. It revealed that in December of the previous year, a Michigan man had received a left kidney from a deceased donor in Idaho at the University of Toledo Medical Center in Ohio. Approximately five weeks later, the patient developed tremors, lower extremity weakness, confusion, and urinary incontinence. A week after the onset of symptoms, he was hospitalized with fever, hydrophobia, difficulty swallowing, and autonomic dysfunction. On the second day of his hospital stay, he required mechanical ventilation.
Because the symptoms resembled rabies, doctors consulted with the local health department and the CDC, and subsequent questioning revealed that the donor had been scratched by a skunk 42 days before his death. He died on the seventh day of hospitalization. Autopsy samples of the brain and antemortem saliva, skin, serum, and cerebrospinal fluid were sent to the CDC for testing. They were found to contain viral RNA and antibodies to the rabies virus, which is specific to the bat Lasionycteris noctivagans, a member of the Vespertilionidae family.
A survey of the donor's relatives revealed that in September 2024, he encountered a skunk on his rural property while holding a kitten. The man, who believed the skunk's behavior to be predatory, fought it off, sustaining a bleeding scratch, while the skunk remained unconscious. Approximately five weeks later, the future donor developed difficulty swallowing and walking, a stiff neck, confusion, and hallucinations. Two days later, he was found at home with suspected cardiac arrest. He was resuscitated and hospitalized, but never regained consciousness. On the fifth day of his hospital stay, he was declared brain dead and taken off life support. His left kidney, heart, lungs, and corneas from both eyes were removed for transplant.
After rabies was suspected, specialists analyzed the donor's blood serum obtained on the third day of hospitalization and found no antibodies to the rabies virus. During a lengthy investigation, they located and identified kidney biopsies. The right kidney tested positive for RNA of the same virus variant as the recipient, but the left kidney tissue was insufficient for analysis. The investigation concluded that the transplanted kidney was the source of the infection.
Tracing the fate of the donor's other organs revealed that three people had received corneal implants. Even before the donor's rabies was confirmed, the corneas were removed preemptively, and the recipients were given post-exposure prophylaxis, and none developed symptoms. Viral RNA was detected in one of the grafts. The donor's heart and lungs were not transplanted but used for medical training; samples from them had not been preserved by the time of the investigation. CDC researchers identified 357 people who had been in contact with the skunk, the donor, the recipient, and their biomaterials. After assessing their risk of infection, 46 of them were given post-exposure prophylaxis.
Previously, British researchers presented the results of trials of a vector-based rabies vaccine. Unlike other vaccines, the drug induced antibody production after the first dose and had a satisfactory safety profile.
