HTLV-1-associated myelopathy in a solid organ transplant recipient

Abstract

Human T-cell lymphotropic virus type-1 (HTLV-1) is endemic in Japan, the Caribbean and in South American countries such as Ecuador. This virus is the cause of HTLV-1-associated myelopathy or tropical spastic paraparesis (HAM/TSP), a myelopathy characterised by chronic progressive paraparesis, spasticity and urinary symptoms. We report the case of a 40-year-old man who received a kidney transplant from a living donor and developed HAM/TSP, 24 months after transplant. The diagnosis was confirmed by detection of HTLV-1 in blood and cerebrospinal fluid by the ELISA and Western Blot tests. For myelopathy, the patient was treated with pulse methylprednisolone, but had poor response to treatment. We recommend that all patients receiving transplants and their donors who come from endemic countries be given a mandatory screening for HTLV-1 through an ELISA test, in an effort to inform candidates for renal transplantation of the potential risk of infection and the development of this disease.

<p>A high prevalence of human T-lymphotropic virus (HTLV 1/2) infection among Afro-descendants, Esmeraldas province, Ecuador – need for the implementation of surveys and control programs</p>

“…However, it is well known that prevalence studies of HTLV infection from the 1980s and 1990s were inaccurate due to the low sensitivity and specificity of the immunological assays used 2. In addition to this report, there are two publications showing clinical cases of TSP in the country associated with HTLV infection,21,22 and there is a recent report concerning the transmission of HTLV-1 from an infected kidney donor 15…”

“…This report showed a seroprevalence of 9.9% in the overall population and a confirmed prevalence with a Western blot of 2.8%. No further studies were undertaken since 1994 to determine the prevalence in other high-risk group in the country, but Ecuador published three case reports concerning HTLV-1 infection in recent years 15,21,22…”

“…HTLV transmission is similar to other retrovirus like HIV, hepatitis B, and C viruses. The most important routes of transmission are the mother-to-child transmission due to prolonged breast feeding, unsafe sexual habits, blood transfusion, and organ transplantation 2,7,14,15…”

Rapid subacute myelopathy following kidney transplantation from HTLV-1 donors: role of immunosuppresors and failure of antiretrovirals

“…Similar cases of HAM/TSP shortly after transplantation have been reported in the literature (Table 1). [13][14][15][16][17][18][19][20][21][22][23][24][25] Myelopathy was originally reported in a heart transplant recipient in France following HTLV-1 acquisition from contaminated blood transfusions during the surgery. 13 In Spain, two kidney recipients and one liver transplant recipient who received organs from a single deceased HTLV-1 donor developed HAM/TSP within 2 years.…”

Human T‐lymphotropic virus type 1 infection and solid organ transplantation

“…In the UK, HAM developed in the renal transplant recipient 36 months after infection was initially progressing rapidly (use of walking aid within 3 months of first symptoms) and is steroid sensitive, requiring high doses of prednisolone in addition to renal transplant related immunosuppression with mycophenolate and ciclosporin, to restore mobility to almost normal. Recent case reports from Japan, Ecuador, and the USA paint the same picture: 2 cases of living donor renal transplantation in Japan with donations by an HTLV‐1 seropositive mother and a seropositive wife to an HTLV seronegative daughter and a seronegative husband, being followed by onset of HAM 8 months and 3 years later respectively; HAM developing 36 months following transplantation in a 40 year old male in Ecuador (albeit pre‐transplantation and donor serostatus not known); HAM developing 5 months following renal transplant related HTLV‐1 infection in a 56‐year‐old male in USA and becoming wheel‐chair dependent within 6 months of the onset of symptoms …”