American Journal of Transplantation 2014; 14: 2417–2421 Wiley Periodicals Inc.
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Copyright 2014 The American Society of Transplantation and the American Society of Transplant Surgeons doi: 10.1111/ajt.12849
Case Report
Donor-Transmitted HTLV-1-Associated Myelopathy in a Kidney Transplant Recipient—Case Report and Literature Review P. Ramanan1,2, P. J. Deziel1,2, S. M. Norby2,3, J. D. Yao4, I. Garza5 and R. R. Razonable1,2,* 1
Division of Infectious Diseases, Mayo Clinic, Rochester, MN 2 William J. von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, MN 3 Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 4 Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 5 Department of Neurology, Mayo Clinic, Rochester, MN Corresponding author: Raymund R. Razonable, [email protected]
Clinical disease due to human T cell lymphotropic virus type 1 (HTLV-1), a retrovirus endemic in certain regions of the world, is rarely reported after solid organ transplantation. In 2009, universal deceased donor organ screening for HTLV-1 was discontinued in the United States. We report the first case of donor-derived HTLV-1-associated myelopathy in a kidney transplant recipient from the United States. The patient, who was HTLV-1-seronegative prior to transplantation, likely acquired HTLV-1 infection from a seropositive organ donor. In this era when screening of donors and recipients for HTLV infection is not mandatory, clinicians should be vigilant in recognizing the risk and potential occurrence of this donor-derived infection in recipients with epidemiologic exposures. Abbreviations: ATL, adult T cell leukemia; CMV, cytomegalovirus; CSF, cerebrospinal fluid; Dþ/R, donor-seropositive/recipient-seronegative; HAM, HTLV-associated myelopathy; HTLV, human T cell lymphotropic virus; OPO, organ procurement organizations; OPTN, Organ Procurement and Transplant Network Received 23 January 2014, revised and accepted for publication 20 May 2014
Introduction Human T cell lymphotropic virus type 1 (HTLV-1) is an enveloped RNA virus belonging to the family Retroviridae. It
infects approximately 15–20 million people worldwide, particularly in endemic regions of southwestern Japan, Caribbean, sub-Saharan Africa, parts of South America, Middle East and Oceania (1). In the United States, the prevalence of HTLV infection among blood donors is 0.035– 0.046% (2). In endemic regions, HTLV-1 infection is believed to be transmitted through body fluids such as infected breast milk. However, other modes of transmission, such as transfusion of cell-containing blood products and solid organ transplantation, have been reported (2). Infection with HTLV-1 is asymptomatic in the majority of individuals and leads to lifelong persistence in the host. In
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Copyright 2014 The American Society of Transplantation and the American Society of Transplant Surgeons doi: 10.1111/ajt.12849
Case Report
Donor-Transmitted HTLV-1-Associated Myelopathy in a Kidney Transplant Recipient—Case Report and Literature Review P. Ramanan1,2, P. J. Deziel1,2, S. M. Norby2,3, J. D. Yao4, I. Garza5 and R. R. Razonable1,2,* 1
Division of Infectious Diseases, Mayo Clinic, Rochester, MN 2 William J. von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, MN 3 Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 4 Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 5 Department of Neurology, Mayo Clinic, Rochester, MN Corresponding author: Raymund R. Razonable, [email protected]
Clinical disease due to human T cell lymphotropic virus type 1 (HTLV-1), a retrovirus endemic in certain regions of the world, is rarely reported after solid organ transplantation. In 2009, universal deceased donor organ screening for HTLV-1 was discontinued in the United States. We report the first case of donor-derived HTLV-1-associated myelopathy in a kidney transplant recipient from the United States. The patient, who was HTLV-1-seronegative prior to transplantation, likely acquired HTLV-1 infection from a seropositive organ donor. In this era when screening of donors and recipients for HTLV infection is not mandatory, clinicians should be vigilant in recognizing the risk and potential occurrence of this donor-derived infection in recipients with epidemiologic exposures. Abbreviations: ATL, adult T cell leukemia; CMV, cytomegalovirus; CSF, cerebrospinal fluid; Dþ/R, donor-seropositive/recipient-seronegative; HAM, HTLV-associated myelopathy; HTLV, human T cell lymphotropic virus; OPO, organ procurement organizations; OPTN, Organ Procurement and Transplant Network Received 23 January 2014, revised and accepted for publication 20 May 2014
Introduction Human T cell lymphotropic virus type 1 (HTLV-1) is an enveloped RNA virus belonging to the family Retroviridae. It
infects approximately 15–20 million people worldwide, particularly in endemic regions of southwestern Japan, Caribbean, sub-Saharan Africa, parts of South America, Middle East and Oceania (1). In the United States, the prevalence of HTLV infection among blood donors is 0.035– 0.046% (2). In endemic regions, HTLV-1 infection is believed to be transmitted through body fluids such as infected breast milk. However, other modes of transmission, such as transfusion of cell-containing blood products and solid organ transplantation, have been reported (2). Infection with HTLV-1 is asymptomatic in the majority of individuals and leads to lifelong persistence in the host. In
