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Post-transplantation HTLV-1 myelopathy in three recipients from a single donor

¹ Department of Neurology, Hospital of Cruces, Baracaldo, Vizcaya, Spain
² Department of Microbiology, Hospital of Cruces

Correspondence to:
Correspondence to:
Dr J C Gomez Esteban, Servicio de Neurologia, Hospital de Cruces sn CP 48903 Baracaldo, Vizcaya, Spain;
jgomeze{at}meditex.es

Methods: The determination of antibodies for HTLV-I/II on samples of serum and cerebral spinal fluid from the patients and the donor was performed by enzyme immunoassay and western blot. Analysis of proviral DNA was performed by polymerase chain reaction. To detect changes in the sequence of aminoacids, the tax gene was sequentiated, amplified, and compared with ATK prototype stocks. Spinal cord magnetic resonance imaging, cerebral spinal fluid, and somatosensory evoked potential studies were carried out in all patients.

Results: All three transplanted patients developed a myelopathy within a very short period of time. In all three patients and donor the virus belonged to the Cosmopolitan A subtype. The homology of HTLV-I sequences recovered from the patients and donor was 100% in all four cases. Proviral load was high in all three patients. The factors that certainly contributed to the infection in the first place, and the development of the disease later, were on the one hand the high proviral load and their immunosupressed condition, and on the other the virus genotype, which proved to be an aggresive variant. However, the analysis of the histocompatibility antigen showed that two of the patients carried an haplotype that has been associated with a lower risk of developing this disease.

Conclusions: It is argued that, although in Spain and other European countries there is not compulsory screening for HTLV antibodies because of the studies that show a low seroprevalence, in view of the cases here reported, and to avoid the serious consequences that such infection has on transplanted patients, compulsory screenings, both on organ donors and on blood banks, should be implemented.

Keywords: myelopathy; HTLV-I; proviral load; immunosuppression; organ transplant

Abbreviations: HTLV-1, human T Lymphotropic virus type 1; CSF, cerebral spinal fluid; MRI, magnetic resonance imaging; SEP, somatosensory evoked potential; PCR, polymerase chain reaction; ELISA, enzyme linked immunosorbent assay

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