HTLV-1 in Solid-Organ Transplantation

Abstract

Human T-cell lymphotrophic virus (HTLV)-1 has been reported after solid-organ transplantation, with a related fatal outcome in less than five cases. The natural history of HTLV-1 transmission from donor to recipient is unknown in this setting, because available screening platforms are suboptimal in low-prevalence areas and there is a lack of long-term follow-up. Minimizing organ wastage due to false-positive screening and avoiding donor-derived HTLV-associated diseases remain the goal. To date, only six HTLV-naive organ recipients from four donors (only one had confirmed HTLV) have developed HTLV-associated disease after transplantation. All of these cases were described in countries or from donors from HTLV-endemic regions. To the best of our knowledge, there have been no reported cases of donor-derived HTLV-1-associated death after organ transplantation in the world. Based on data from low-prevalence countries (Europe and the United States) and the current shortage of donor organs, it appears plausible to authorize the decision to transplant an organ without the prior knowledge of the donor's HTLV-1 status. Currently, it is not possible to exclude such transmission and recipients should be informed of the possible inadvertent transmission of this (and other) infections at the time of consent. In those cases where HTLV-1 transmission does occur, there may be a therapeutic window in which use of antiviral agents (i.e., zidovudine and raltegravir) may be of benefit. The development of national/international registries should allow a greater understanding of the extent and consequences of transmission risk and so allow a more evidence-based approach to management.

Guidelines for the assessment and acceptance of potential brain-dead organ donors

“…Although there are reports of disease transmission to six organ recipients from four donors, only one of whom had confirmed HTLV infection, no case of recipient death by infection with HTLV has yet been reported (D) . ( 73 , 74 , 106 , 107 ) Thus, some countries with a low prevalence of HTLV infection (United States and England) and an insufficient number of donors to meet the increasing demand for transplant organs allow the performance of transplants without previous knowledge of the HTLV status of the donor (D) . ( 73 , 74 , 106 , 107 )…”

Severe Strongyloides stercoralis infection in kidney transplant recipients: A multicenter case-control study

“…As a result, the true incidence of severe S. stercoralis infection might have been underestimated. Second, we were unable to collect data on the human T-lymphotropic virus (HTLV) infection status of the recipients, a variable that has been shown to affect the clinical course of S. stercoralis infection [39,40]. Such information is not systematically collected for transplant recipients in Brazil.…”

“…Such information is not systematically collected for transplant recipients in Brazil. Although the actual prevalence of HTLV infection after kidney transplantation is unknown, many studies have found low rates of HTLV seropositivity in transplant recipients [39,40]. Although there have been some reports of myelopathy after donor-transmitted infection, it seems that the clinical course of infection in recipients testing positive for HTLV prior to transplantation is benign even under immunosuppression [39,40].…”

“…Although the actual prevalence of HTLV infection after kidney transplantation is unknown, many studies have found low rates of HTLV seropositivity in transplant recipients [39,40]. Although there have been some reports of myelopathy after donor-transmitted infection, it seems that the clinical course of infection in recipients testing positive for HTLV prior to transplantation is benign even under immunosuppression [39,40]. In addition, there have been no reports of an association between HTLV and strongyloidiasis in transplant recipients, although most studies of the topic have been conducted in countries with a low prevalence of strongyloidiasis [39,40].…”

“…Although there have been some reports of myelopathy after donor-transmitted infection, it seems that the clinical course of infection in recipients testing positive for HTLV prior to transplantation is benign even under immunosuppression [39,40]. In addition, there have been no reports of an association between HTLV and strongyloidiasis in transplant recipients, although most studies of the topic have been conducted in countries with a low prevalence of strongyloidiasis [39,40]. Finally, we had no access to data on donor or recipient screening for S. stercoralis infection before transplantation.…”