肾移植后供者来源狂犬病二例疗效观察

Trasmission of rabies virus from an organ donor to two renal transplant recipients

目的 探讨肾移植后供者来源狂犬病的临床特点、诊疗方案以及防治策略.方法 回顾2例肾移植后确诊狂犬病受者的病例资料以及既往生活情况,获取供者详细资料,判断受者狂犬病是否经肾移植传播.采集受者的唾液、尿液、痰液样本并进行相关实验室检查,病毒检测采用逆转录聚合酶链反应检测狂犬病毒核蛋白基因的方法.结果 供者为6岁男童,因不明原因引起的病毒性脑炎死亡,并捐献双侧肾脏以及双侧角膜.2例接受该供者肾脏的移植受者先后出现神经病变症状以及狂犬病特异性症状,经治疗无效,分别于发病后44和34 d死亡.经检查,2例受者唾液、尿液和痰液样本狂犬病毒核酸均呈阳性.追问病史,供者曾与家犬有频繁接触史,家属否认供者被动物咬伤史,供者无狂犬病疫苗接种史.2例受者家属均否认受者饲养宠物史,否认受者被动物咬伤史,受者均无狂犬病疫苗接种史.结论 狂犬病可以通过器官移植传播.供者来源狂犬病潜伏期较短,一旦发病治疗效果极差,死亡率高.对于不能完全除外狂犬病,尤其是不明原因脑炎的供者器官,应酌情弃用.而对于已接受狂犬病供者器官移植但尚未发病的受者,应积极采取预防措施.

Objective To investigate the clinical characteristics and strategy of prophylaxis and treatment of rabies.Methods Two recipients and their donors with rabies were reviewed to confirm the transmission through kidney transplantation.Saliva,urine,and sputum samples from recipients were collected for the detection of rabies virus by reverse transcription PCR （RT-PCR）.Results The donor was a 6-year old boy,died of viral encephalitis of unknown cause.His kidneys and corneas were donated for transplantation.Two recipients who received the donor kidneys had neurological symptoms associated with rabies successively.Both of the two recipients died 44 days and 34 days after onset of post-transplant symptoms.Saliva,urine,and sputum samples were positive for rabies virus nucleic acid.The epidemiological investigation revealed that the boy had a history of close contact with his dog.The parents denied the history of animal bites or rabies prophylaxis.Conclusion The rabies virus can be transmitted through organ transplantation.Incubation period of rabies transmitted from donor is shorter than general population and the mortality rate is up to 100% after onset of symptoms.So,both coordinators and doctors should deeply understand the rabies.The evaluation and supervision of donor derived diseases should be strengthened.The donors should not be donated whenever the rabies is not completely excluded,especially those died of encephalitis of unknown cause.Furthermore,post-exposure prophylaxis of rabies should be administered as soon as possible before onset of symptoms after transplant from a donor with rabies.