Transmission of human T-lymphotropic virus type I by bilateral living-donor lobar lung transplantation
2009; Elsevier BV; Volume: 138; Issue: 1 Linguagem: Inglês
10.1016/j.jtcvs.2008.12.050
ISSN1097-685X
AutoresSatomi Yara, Jiro Fujita, Hiroshi Date,
Tópico(s)Vector-Borne Animal Diseases
ResumoTo the Editor: Human T-lymphotropic virus type I (HTLV-I) is an etiologic agent for adult T-cell leukemia/lymphoma and HTLV-I–associated myelopathy/tropical spastic paraparesis. Most HTLV-I infections are attributable to transmission from mother to child or to sexual contact later in life, whereas transfusion is perhaps the most efficient mode of viral transmission. Seroprevalence of HTLV-1 among high-risk populations is 10% to 30% in the southern area of Japan, such as Okinawa, and approximately 5% in the Caribbean region compared with 1% in Europe and the United States. There have been several reports of HTLV-1 transmission in association with organ transplantation (Table 1).1Remesar M.C. del Pozo A.E. Pittis M.G. Mangano A.M. Sen L. Briones L. Transmission of HTLV-1 by kidney transplant.Transfusion. 2000; 40: 1421Crossref PubMed Scopus (26) Google Scholar, 2Nakatsuji Y. Sugai F. Watanabe S. Kaido M. Koguchi K. Abe K. et al.HTLV-I-associated myelopathy manifested after renal transplantation.J Neurol Sci. 2000; 177: 154-156Abstract Full Text Full Text PDF PubMed Scopus (29) Google Scholar, 3Toro C. Rodés B. Poveda E. Soriano V. Rapid development of subacute myelopathy in three organ transplant recipients after transmission of a human T-cell lymphotrophic virus type I from a single donor.Transplantation. 2003; 75: 102-104Crossref PubMed Scopus (102) Google Scholar, 4Zarranz Imirizaldu J.J. Gomez Esteban J.C. Rouco Axpe I. Perez Concha T. Velasco Juanes F. et al.Post-transplantation HTLV-1 myelopathy in three recipients from a single donor.J Neurol Neurosurg Psychiatry. 2003; 74: 1080-1084Crossref PubMed Scopus (46) Google Scholar However, no report describes a transmission of HTLV-1 by lung transplantation. We describe the first case of HTLV-1 transmission from a seropositive donor via lung transplantation.Table 1Review of the literature about transmission of human T-lymphotropic virus type I after solid-organ transplantationFirst authorYearAge and sexOrganClinical featuresReferencesRemesar2000DaughterKidneyNone1Remesar M.C. del Pozo A.E. Pittis M.G. Mangano A.M. Sen L. Briones L. Transmission of HTLV-1 by kidney transplant.Transfusion. 2000; 40: 1421Crossref PubMed Scopus (26) Google ScholarNakatsuji200050 MKidneyHTLV-1–associated myelopathy2Nakatsuji Y. Sugai F. Watanabe S. Kaido M. Koguchi K. Abe K. et al.HTLV-I-associated myelopathy manifested after renal transplantation.J Neurol Sci. 2000; 177: 154-156Abstract Full Text Full Text PDF PubMed Scopus (29) Google ScholarToro200353 F∗The same patients.KidneySubacute myelopathy3Toro C. Rodés B. Poveda E. Soriano V. Rapid development of subacute myelopathy in three organ transplant recipients after transmission of a human T-cell lymphotrophic virus type I from a single donor.Transplantation. 2003; 75: 102-104Crossref PubMed Scopus (102) Google ScholarToro200355 M†The same patients.KidneySubacute myelopathy3Toro C. Rodés B. Poveda E. Soriano V. Rapid development of subacute myelopathy in three organ transplant recipients after transmission of a human T-cell lymphotrophic virus type I from a single donor.Transplantation. 2003; 75: 102-104Crossref PubMed Scopus (102) Google ScholarToro200344 F‡The same patients.LiverSubacute myelopathy3Toro C. Rodés B. Poveda E. Soriano V. Rapid development of subacute myelopathy in three organ transplant recipients after transmission of a human T-cell lymphotrophic virus type I from a single donor.Transplantation. 2003; 75: 102-104Crossref PubMed Scopus (102) Google ScholarZarranz200354 F∗The same patients.KidneyMyelopathy4Zarranz Imirizaldu J.J. Gomez Esteban J.C. Rouco Axpe I. Perez Concha T. Velasco Juanes F. et al.Post-transplantation HTLV-1 myelopathy in three recipients from a single donor.J Neurol Neurosurg Psychiatry. 2003; 74: 1080-1084Crossref PubMed Scopus (46) Google ScholarZarranz200357 M†The same patients.KidneyMyelopathy4Zarranz Imirizaldu J.J. Gomez Esteban J.C. Rouco Axpe I. Perez Concha T. Velasco Juanes F. et al.Post-transplantation HTLV-1 myelopathy in three recipients from a single donor.J Neurol Neurosurg Psychiatry. 2003; 74: 1080-1084Crossref PubMed Scopus (46) Google ScholarZarranz200344 F‡The same patients.LiverMyelopathy4Zarranz Imirizaldu J.J. Gomez Esteban J.C. Rouco Axpe I. Perez Concha T. Velasco Juanes F. et al.Post-transplantation HTLV-1 myelopathy in three recipients from a single donor.J Neurol Neurosurg Psychiatry. 2003; 74: 1080-1084Crossref PubMed Scopus (46) Google ScholarYara200842 FLungNonePresent reportHTLV, Human T-lymphotropic virus type I.∗, †, ‡ The same patients. Open table in a new tab HTLV, Human T-lymphotropic virus type I. A 38-year-old woman had abnormal shadows on a chest x-ray at a healthcare examination. Video-assisted thoracoscopic surgical lung biopsy was performed, and usual interstitial pneumonia was diagnosed. Despite some drug treatments, she had dry cough and dyspnea that gradually worsened. In 2003, at the age of 42 years, she was considered eligible for bilateral living-donor lobar lung transplantation at Okayama University. The patient was negative for anti-HTLV-I antibody. The younger sister was positive less than 16 times for anti-HTLV-I antibody. Because the patient's condition was severe and deteriorating, she was considered to be in urgent need of lung transplantation. In addition, there are no reports of HTLV-I transmission by lung transplantation. Therefore, lung transplantation was performed using lungs from an elder brother and a younger sister in August 2003. Before the transplant, the lungs were flushed with 1 L of Euro-Collins solution, which consists of 115 mmol/L monopotassium, 10 mmol/L sodium, and 3.6% glucose, both antegradely and retrogradely.5Date H. Aoe M. Nagahiro I. Sano Y. Andou A. Matsubara H. et al.Living-donor lobar lung transplantation for various lung disease.J Thorac Cardiovasc Surg. 2004; 126: 476-481Abstract Full Text Full Text PDF Scopus (93) Google Scholar The patient's general condition improved after the lung transplantation. In November 2008, her oxygen saturation was 98% to 99% at room air. However, serologic follow-up demonstrated that she had acquired HTLV-I infection posttransplantation. Antibody titers were as follows: 256 times after 9 months, more than 8192 times in August 2006, 2048 times in April 2008. Remesar and colleagues1Remesar M.C. del Pozo A.E. Pittis M.G. Mangano A.M. Sen L. Briones L. Transmission of HTLV-1 by kidney transplant.Transfusion. 2000; 40: 1421Crossref PubMed Scopus (26) Google Scholar reported the first case of HTLV-1 infection transmitted by organ transplantation (a child who received a kidney from her infected mother). The seroconversion was observed 83 days after transplantation. Nakatsuji and colleagues2Nakatsuji Y. Sugai F. Watanabe S. Kaido M. Koguchi K. Abe K. et al.HTLV-I-associated myelopathy manifested after renal transplantation.J Neurol Sci. 2000; 177: 154-156Abstract Full Text Full Text PDF PubMed Scopus (29) Google Scholar described a kidney transplant recipient who presented with tropical spastic paraparesis 4 years posttransplantation. Toro and colleagues3Toro C. Rodés B. Poveda E. Soriano V. Rapid development of subacute myelopathy in three organ transplant recipients after transmission of a human T-cell lymphotrophic virus type I from a single donor.Transplantation. 2003; 75: 102-104Crossref PubMed Scopus (102) Google Scholar reported the transmission of HTLV-1 from a single donor to 3 organ (2 kidneys and 1 liver) transplant recipients, who subsequently developed tropical spastic paraparesis within 2 years posttransplant. Although the lungs were pretreated with preservative solution, transmission of HTLV-1 could not be prevented. Approximately 5 years posttransplant, our patient demonstrates neither neurologic nor hematologic evidence of HTLV-I–related disease. However, this patient should be followed up for adult T-cell leukemia/lymphoma and tropical spastic paraparesis.
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