West Nile Virus

Common donor residing in a region of increased WNV activity. Donor investigated retrospectively and found to be WNV IgM and IgG positive and WNV RNA negative in serum but positive in lympho reticular tissue. All four transplant recipients had molecular evidence of WNV infection in their serum and/or cerebrospinal fluid (CSF) by reverse transcription polymerase chain reaction (RT-PCR) testing. One kidney recipient and lung recipient died of WNV encephalitis, the other kidney recipient had mild symptoms and recovered. All four received polyvalent human intravenous immunoglobulin. When the transplant physicians were notified of WNV infection in the two kidney recipients from the same donor, the liver recipient tested positive for WNV RNA in CSF and was treated with oral ribavirin plus polyvalent intravenous immunoglobulin. He underwent a second liver transplant surgery for delayed nonfunction of the first graft. WNV RT-PCR testing on tissue from the first liver graft was negative.