A case report of HTLV-1 associated myelopathy (HAM) manifested after renal transplantation

Abstract

We report a 51-year-old man with human T lymphotropic virus type-1 (HTLV-1) associated myelopathy (HAM) manifested 10 months after renal transplantation. He had progressive spastic paralysis and neurogenic bladder for 10 years. HTLV-1 antibody are positive both serum and cerebral spinal fluid (CSF). Althoght HTLV-1 was not examined in the donor, it was suspected that the patient was infected by renal transplantation. After treatment of interferon-alpha (IFN-alpha), his motor function had improved and neopterin in CSF was decreased from 158 pmol/ml to 89 pmol/ml. This is a rare case of HAM after living renal transplantation. Cyclosporin and methylpredonisolone are used as immunosuppressants for preventing graft rejection. Time for developing HAM after renal transplantation was shorter than patients after cadaveric renal transplantation. More investigations are needed to clarify the mechanisms in the development of HAM associated with renal transplantation.

Screening transplant donors for HTLV-1 and -2

“…2 These posttransplant HAM cases occurred with rapid onset and rapid progression. [9][10][11] These findings call into question the current widespread view that systemic HTLV screening of donated organs is unnecessary: this view is based on the assumption that HTLV-1-associated diseases will develop only in a small proportion of infected individuals and that progression to disease is slow compared with the average lifespan of humans and therefore poses no major threats to public health.…”

Human T Lymphotropic Virus Type-1-associated Myelopathy Manifesting Shortly after Living-donor Renal Transplantation

“…The development of HAM after following renal transplantation has been reported in six cases to date (12)(13)(14)(15)(16) (Table). In previous cases, the period between transplantation and the onset of HAM ranged between 17 months and 7 years (mean: 3.3 years) after cadaveric renal transplantation and only 10 and 11 months after living-donor renal transplantation (16). Therefore, the two-month period to onset observed in the present case is much shorter than that previously reported.…”

“…Renal transplantation is not normally considered to be a risk factor for the onset of HAM in HTLV-1-carrier recipients (17,18). Other reports of the development of HAM following renal transplantation have also described the possible transmission from an infected donor (12)(13)(14)(15)(16). However, reports of causative correlations between infection from an HTLV-1-carrier donor and the onset of HAM are rare.…”

“…The onset of HAM is insidious, with neurological symptoms usually appearing in the fourth or fifth decade of life (7,10). HAM occurs more frequently in cases in which HTLV-1 is acquired through blood transfusion or renal transplantation, often with a shorter duration of latency (11)(12)(13)(14)(15)(16). We herein report a case of HAM caused by renal transplantation from a living donor and discuss possible mechanisms underlying the rapid onset and progression of HAM.…”

Donor-Transmitted HTLV-1-Associated Myelopathy in a Kidney Transplant Recipient—Case Report and Literature Review

“…These include nine kidney recipients (7)(8)(9)(10)(11)(12), two liver recipients (10,13) and one heart recipient (14). Note that these previously reported cases included reactivation disease in HTLV-1/2-seropositive recipients, de novo primary infection and donor-derived infection.…”