Zika in Transplant Recipients

Summary and Comment |
April 7, 2017

Zika in Transplant Recipients

  1. Sonia Nagy Chimienti, MD

Both bacterial superinfection and allograft dysfunction were seen in a small series of transplant recipients with Zika virus infection.

  1. Sonia Nagy Chimienti, MD

This brief communication describes Zika virus infection in four transplant recipients (two liver and two kidney recipients) in Brazil. Of 187 solid organ transplants performed between January 2015 and April 2016 at a single center, 40 patients (29 kidney and 11 liver transplant recipients) were suspected of having arbovirus infection and were tested according to protocol for dengue, Zika, chikungunya, Saint Louis encephalitis virus, Rocio virus, Ilhéus virus, Bussaquara virus, Iguape virus, and West Nile virus. Zika virus infection was confirmed with positive RT-PCR, together with negative testing for the other arboviruses.

Each of the four confirmed cases of Zika infection was diagnosed between June 2015 and January 2016, during the epidemic in Brazil. The patients presented with variable symptoms, such as fever, myalgia, headache, cough, coryza, weight loss, vomiting, and diarrhea. No patient had neurological symptoms at hospital admission. Three patients had anemia; all had thrombocytopenia (platelets <100,000) and allograft dysfunction. Three patients developed a bacterial infection during the hospitalization for Zika virus infection (biliary abscess; cholangitis; MRSA bacteremia and pneumonia). The duration between symptom onset and hospitalization was slightly longer than expected (7.25 ± 2.06 days; range 5–10 days). There were no fatalities attributable to Zika virus infection and no neurologic sequelae.


Little is known about the presentation of Zika virus infection in immunocompromised hosts, and this small series cannot provide definitive information about clinical features and complications in transplant recipients. However, bacterial superinfection may be a common complication, and serious allograft dysfunction is likely to be a concern. Testing for Zika virus in transplant recipients should likely be performed when infection is suspected, even if outside the expected window. Clinicians should be alert to Zika as a potential cause of infection in recipients who reside in or have traveled to endemic areas or whose donors have traveled to an area with documented Zika virus transmission.

Editor Disclosures at Time of Publication

  • Disclosures for Sonia Nagy Chimienti, MD at time of publication Nothing to disclose


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