Status:
Ready to upload
Record number:
1830
Adverse Occurrence type:
MPHO Type:
Estimated frequency:
There is limited data on estimated frequency of donor-to-recipient transmission in non-endemic regions and no published data in endemic regions. In non-endemic regions, HTLV-1 transmission is very rare.
Time to detection:
Symptom onset varies from 2 months after transplant to as long as 7 years later. The diagnosis in individual case reports occurred within the same time frame of symptom onset (Gonzalez-Perez et al.) or two years after symptom onset (Nakatsuji et al, Glowacka et al, and Nagamine et al).
Alerting signals, symptoms, evidence of occurrence:
HTLV-1 has two major disease manifestations that present very differently: 1. adult T-cell leukemia/lymphoma (ATLL) and 2. HTLV-1 associated myelopathy (HAM) also known as tropical spastic paraparesis.
For transplant recipients that develop HAM -- typical signs and symptoms include parasthesias, gate disturbances, urinary incontinence, and/or other subacute myelopathy. Cerebral Spinal Fluid samples may yield an elevated white blood cell count, elevated protein, and antibodies to HTLV-1. HTLV-1 antibodies are also present in blood.
For transplant recipients that develop ATLL-- cutaneous lymphoma.
Demonstration of imputability or root cause:
Via DNA sequencing, there is evidence to support donor-to-recipient transmission. Gonzalez-Perez et al. showed transmission via sequencing of specimen from three recipients (two kidneys, one liver) and the donor's mother; results showed conserved long terminal repeat (LTR) among the donor's mother and the the three solid organ transplant recipients. A donor sample was not able to be used for sequencing, but since HTLV-1 can be transmitted via breast milk, mother-to-child transmission does occur, which the authors inferred was the case given the similarity of sequences between the donor's mother and all recipients.
Imputability grade:
3 Definite/Certain/Proven
Groups audience:
Keywords:
References:
Suggest new keywords:
T cell lymphoma
T cell leukemia
Parasthesia
HTLV-1
Reference attachment:
Suggest references:
1) Human T lymphotropic virus type-1-associated myelopathy manifesting shortly after living-donor renal transplantation. Nagamine Y et al. Intern Med. 54(1):75-8, 2015.
2) Human T-cell leukemia virus type I infection in various recipients of transplants from the same donor. González-Pérez MP, et al. Transplantation. 2003.
3) Rapid development of subacute myelopathy in three organ transplant recipients after transmission of human T-cell lymphotropic virus type I from a single donor. Toro C, et al. Transplantation. 2003 Jan 15;75(1):102-4
4) Nakatsuji, Y.; Sugai, F.; Watanabe, S.; Kaido, M.; Koguchi, K.; Abe, K.; Sakoda, S. HTLV-I-associated myelopathy manifested after renal transplantation J Neurol Sci 2000; 177 (2) :154 - 6
5) Glowacka, I., K. Korn, S. A. Potthoff, U. Lehmann, H. H. Kreipe, K. Ivens, H. Barg-Hock, T. F. Schulz and A. Heim (2013). "Delayed Seroconversion and Rapid Onset of Lymphoproliferative Disease After Transmission of Human T-Cell Lymphotropic Virus Type 1 From a Multiorgan Donor." Clinical Infectious Diseases 57(10): 1417-1424 2)
6) Armstrong, M. J., C. Corbett, I. A. Rowe, G. P. Taylor and J. M. Neuberger (2012). "HTLV-1 in solid-organ transplantation: current challenges and future management strategies." Transplantation 94(11): 1075-1084.
Note:
From MG:
Record 1427 also HTLV / Kidney (imputability possible) with no expert comments
Record 952 also HTLV / Kidney (imputability possible) with no expert comments
Record 430 HTLV/ Kidney (imputability Definite) with no expert comments
*** when the reviewer is ready to work on the records, please let Evi, Claudia, and Aurora know so they can open these records to review ***
From Rebecca: I have encorporated 1743, 952, 430, and 1830 into this entry. The entries from 430 describe the same set of donor + recipients, but the paper by Gonzalez-Perez et al. is the better of the two papers and the one that truly shows definite transmission via DNA sequeencing from donor's mother and all recipients.
Amongst these 3 records + the current record, reviewer please select the one with the most convincing evidence and use that as the "base" record, add reference citation from the other records to that base record, summarize the overall information into that base record, and add expert comments that speak to the state of the art on HTLV and organ transplantation (can link to various outside information sources, like this HRSA guidance https://optn.transplant.hrsa.gov/professionals/by-topic/guidance/guidance-for-htlv-1-screening-and-confirmation-in-potential-donors-and-reporting-potential-htlv-1-infection/ )
Melissa 6/22/24: (After our 6/20 meeting) - what we need is for Evi to please add the references from those other records to this record, do your keyword check, and then publish this record, and reject the other records listed above. (records: 1743, 952, 430, and 1830) - DONE (EP)
And I asked Oscar to double-check if anything clinical could be added.
Expert comments for publication:
HTLV-1 transmission seems to occur infrequently in non-endemic regions. Additionally, long term outcomes for the patients with suspected donor derived HTLV-1 are limited for many of the case reports, the case series (Nagamine, et al), or review (Armstrong et al) published in English. Further complicating matters, in non-endemic regions universal screening of donors can lead to false positives, which may discourage some physicians from accepting a donor offer. As such, in 2009 the United States eliminated the requirement for pre-transplant deceased donor HTLV-1/2 testing (https://optn.transplant.hrsa.gov/professionals/by-topic/guidance/guidance-for-htlv-1-screening-and-confirmation-in-potential-donors-and-reporting-potential-htlv-1-infection/). Clinicians should consider the possibility of donor-derived HTLV-1 infection in recipients who develop ATLL or progressive parasthesia. More information is needed for endemic regions as to the risk of HTLV-1 donor-derived infections and outcomes.