Infection with human T lymphotropic virus type I in organ transplant donors and recipients in Spain

Human T-cell lymphotropic virus (HTLV) antibody screening is not recommended uniformly before transplantation in Western countries. In the year 2001, the first cases of HTLV-I infection acquired through organ transplantation from one asymptomatic carrier were reported in Europe. All three organ recipients developed a subacute myelopathy shortly after transplantation. This report rose the question about whether to implement universal anti-HTLV screening of all organ donors or selective screening of donors from endemic areas for HTLV-I infection should be carried out. A national survey was conducted thereafter in which anti-HTLV antibodies were tested in 1,298 organ transplant donors and 493 potential recipients. None was seropositive for HTLV-I and only one recipient, a former intravenous (i.v.) drug user, was found to be infected with HTLV-II. In a different survey, HTLV screening was conducted in 1,079 immigrants and 5 (0.5%) were found to be asymptomatic HTLV-I carriers. All came from endemic areas for HTLV-I infection. No cases of HTLV-II infection were found among immigrants. These results support the current policy of mandatory testing of anti-HTLV antibodies in Spain only among organ transplant donors coming from HTLV-I endemic areas or with a highly suspicion of HTLV-I infection.