Increasing utilization of human T-cell lymphotropic virus (+) donors in liver transplantation: is it safe?

TitleIncreasing utilization of human T-cell lymphotropic virus (+) donors in liver transplantation: is it safe?
Publication TypeJournal Article
Year of Publication2009
AuthorsMarvin MR, Brock GN, Kwarteng K, Nagubandi R, Ravindra KV, Eng M, Buell JF
Pagination1180 - 90
Date Published46478
Type of ArticleResearch Support, N.I.H., Extramural
ISSN1534-6080 (Electronic) 0041-1337 (Linking)
Accession Number19384165
KeywordsAdult, Aged, Deltaretrovirus Infections / *epidemiology, Ethnic Groups, False Positive Reactions, Female, Graft Survival, Hepatitis Delta Virus, Humans, Liver Transplantation / mortality / *statistics & numerical data, Male, Middle Aged, Retrospective Studies, Safety, Survival Rate, Survivors / *statistics & numerical data, Tissue Donors / *statistics & numerical data, Tumor Virus Infections / epidemiology / mortality

BACKGROUND: Liver transplantation is the best treatment option for endstage liver disease. The human T-cell lymphotrophic virus (HTLV) has been associated with leukemia/lymphoma and progressive neurologic disease. There has, however, been an increased utilization of HTLV (+) grafts with little data available to support or discourage their use. METHODS: We performed univariate and multivariate analyses related to graft and patient survival for recipients of HTLV (+) donors and compared them with recipients of HTLV (-) donors using the United Network for Organ Sharing database. Complete analysis of recipient and donor clinical and demographic factors was performed. RESULTS: There were 81 adult recipients of HTLV (+) donors and 29,747 HTLV (-) donor recipients. HTLV (+) donors were more likely to be older, women, and black, with a higher average donor risk index and creatinine, and were more likely to be shared nationally. Recipients of HTLV (+) organs were at slightly elevated risk of graft failure (HR=1.39, 95% CI 0.91-2.11) and death (HR=1.20, CI 0.71-2.02) relative to HTLV (-) donor recipients (P=0.12 and 0.5, respectively). The risk decreased after multivariate analysis - graft survival (HR=1.20, CI 0.79-1.83) and patient survival (HR=1.06, CI 0.63-1.79). CONCLUSION: Our analysis reveals no statistically significant difference in graft or patient survival between recipients of HTLV (+) and (-) donors. Serious limitations of these data are that serologic testing for HTLV has a high false positive rate and that there was a short follow-up period. Until these issues are addressed, extreme caution should be exercised when using these organs.

Alternate JournalTransplantation
Notify Library Reference ID973

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