Clinical Outcome in Human T-Lymphotropic Virus Type 2 Carriers Following Organ Transplantation

Abstract

Background. Frequent and rapid development of myelopathy has been reported in individuals with human T-lymphotropic virus type 1 (HTLV-1) infection following solid organ transplantation. There is no information regarding HTLV-2, a closely related virus that often infects injection drug users. Methods. This study includes a retrospective analysis of all consecutive organ transplants performed during the last 2 decades at a large reference transplantation unit in Spain. All participants were tested for anti-HTLV antibodies. Results. A total of 2019 individuals were tested for HTLV during the study period, including 663 potential donors and 1356 recipient candidates. Twelve (0.59%) were reactive on initial HTLV serologic screening, but only 6 (all recipients) were confirmed as positive, all for HTLV-2. Two recipients underwent liver transplantation and have remained asymptomatic despite being on tacrolimus for 4 and 8 years, respectively. Likewise, the remaining 4 HTLV-2 carriers have not developed clinical complications potentially associated with HTLV-2. Conclusions. Unlike HTLV-1 infection, HTLV-2 infection in the transplantation setting does not seem to be associated with rapid development of neurologic complications, Given the cross-seroreactivity between HTLV-1 and HTLV-2, discriminatory rapid tests are urgently needed and would reduce unnecessary organ discharge.

Low seroprevalence of anti‐human T‐cell leukemia virus‐I/II antibodies among brain‐dead donors in Tuscany—An 8‐year observational study

“…However, it was unknown whether these organs underwent confirmatory testing in the study by Shames et al, 11 and the number of organs rejected because of falsely positive initial screening tests was not reported in the UNOS data. In a retrospective analysis, 13 Though data from this study are comparable in number consistency with that reported by de Mendoza et al, 3 two donors were initially reactive (0.06%) with no evidence of HTLV infection and testing suggests false positive testing.…”

The slowdown of new infections by human retroviruses has reached a plateau in Spain

“…One presented a myopathy with histological confirmation 36 and another developed paraparesis following initiation of antiretroviral therapy to treat HIV‐1, resembling an immune reconstitution inflammatory syndrome 37 . It is noteworthy that clinical manifestations potentially associated to HTLV‐2 does not develop in the transplantation setting, where large inoculum size and immunosuppression might potentiate viral pathogenicity 38 …”

“…37 It is noteworthy that clinical manifestations potentially associated to HTLV-2 does not develop in the transplantation setting, where large inoculum size and immunosuppression might potentiate viral pathogenicity. 38 During 2022, six new cases of HTLV-2 were reported in Spain.…”