A Cluster of Fatal Tick-borne Encephalitis Virus Infection in Organ Transplant Setting

J Infect Dis. 2017 Mar 15;215(6):896-901. doi: 10.1093/infdis/jix040.


Background: Tick-borne encephalitis virus (TBEV) infection has become a major health problem in Europe and is currently a common cause of viral brain infection in many countries. Encephalitis in transplant recipients, althrough rare, is becoming a recognized complication. Our study provides the first description of transmission of TBEV through transplantation of solid organs.

Methods: Three patients who received solid organ transplants from a single donor (2 received kidney, and 1 received liver) developed encephalitis 17-49 days after transplantation and subsequently died. Blood and autopsy tissue samples were tested by next-generation sequencing (NGS) and reverse transcription polymerase chain reaction (RT-PCR).

Results: All 3 recipients were first analyzed in autopsy brain tissue samples and/or cerebrospinal fluid by NGS, which yielded 24-52 million sequences per sample and 9-988 matched TBEV sequences in each patient. The presence of TBEV was confirmed by RT-PCR in all recipients and in the donor, and direct sequencing of amplification products corroborated the presence of the same viral strain.

Conclusions: We demonstrated transmission of TBEV by transplantation of solid organs. In such a setting, TBEV infection may be fatal, probably due to pharmacological immunosuppression. Organ donors should be screened for TBEV when coming from or visiting endemic areas.

Keywords: encephalitis; transplantation; TBEV.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Autopsy
  • Brain / virology*
  • Donor Selection
  • Encephalitis Viruses, Tick-Borne / isolation & purification*
  • Encephalitis, Tick-Borne / etiology
  • Encephalitis, Tick-Borne / transmission*
  • Fatal Outcome
  • Humans
  • Male
  • Middle Aged
  • Organ Transplantation / adverse effects*
  • Poland
  • Postoperative Complications / etiology
  • RNA, Viral / blood
  • Sequence Analysis, RNA
  • Tissue Donors*


  • RNA, Viral