Rapid subacute myelopathy following kidney transplantation from HTLV-1 donors: role of immunosuppresors and failure of antiretrovirals

• Published in: Therapeutic advances in infectious disease Vol. 6; p. 2049936119868028
• Main Authors: Roc, Lourdes, de Mendoza, Carmen, Fernández-Alonso, Miriam, Reina, Gabriel, Soriano, Vicente, Rodríguez, C., Vera, M., Marcaida, G., Ocete, M.D., Caballero, E., Molina, I., Aguilera, A., Rodríguez-Calviño, J.J., Navarro, D., Rivero, C., Vilariño, M.D., Benito, R., Algarate, S., Gil, J., Ortiz de Lejarazu, R., Rojo, S., Eirós, J.M., San Miguel, A., Manzardo, C., Miró, J.M., García, J., Paz, I., Poveda, E., Calderón, E., Escudero, D., Trigo, M., Diz, J., García-Campello, M., Rodríguez-Iglesias, M., Hernández-Betancor, A., Martín, A.M., Ramos, J.M., Gimeno, A., Gutiérrez, F., Rodríguez, J.C., Sánchez, V., Gómez-Hernando, C., Cilla, G., Pérez-Trallero, E., López-Aldeguer, J., Fernández-Pereira, L., Niubó, J., Hernández, M., López-Lirola, A.M., Gómez-Sirvent, J.L., Force, L., Cifuentes, C., Pérez, S., Morano, L., Raya, C., González-Praetorius, A., Pérez, J.L., Peñaranda, M., Hernáez-Crespo, S., Montejo, J.M., Roc, L., Martínez-Sapiña, A., Viciana, I., Cabezas, T., Lozano, A., Fernández, J.M., García-Bermejo, I., Gaspar, G., García, R., Górgolas, M., Vegas, C., Blas, J., Miralles, P., Valeiro, M., Aldamiz, T., Margall, N., Guardia, C., do Pico, E., Polo, I., Aguinaga, A., Ezpeleta, C., Sauleda, S., Pirón, M., González, R., Jiménez, A., Blanco, L., Suárez, A., Rodríguez-Avial, I., Parra, P., Fernández, M., Fernández-Alonso, M., Reina, G., Treviño, A., Requena, S., Benítez-Gutiérrez, L., de Mendoza, C., Barreiro, P., Soriano, V., Corral, O., Gómez-Gallego, F.
• Format: Journal Article
• Language: English
• Published: London, England SAGE Publications 2019; Sage Publications Ltd; SAGE Publishing
• Subjects: Antiretroviral drugs; Antiretroviral therapy; Antiviral agents; Case Report; Central nervous system diseases; Graft rejection; Kidney transplantation; Kidney transplants; Renal failure; Risk assessment; Spinal cord; Surgery; Transplants & implants; Spain; screening; antiretroviral drugs; HTLV-1; transplantation; myelopathy
• ISSN: 2049-9361; 2049-937X
• DOI: 10.1177/2049936119868028

Two kidney transplant recipients from a single donor became infected with HTLV-1 (human T-lymphotropic virus type 1) in Spain. One developed myelopathy 8 months following surgery despite early prescription of antiretroviral therapy. The allograft was removed from the second recipient at month 8 due to rejection and immunosuppressors discontinued. To date, 3 years later, this patient remains infected but asymptomatic. HTLV-1 infection was recognized retrospectively in the donor, a native Spaniard who had sex partners from endemic regions. Our findings call for a reappraisal of screening policies on donor–recipient organ transplantation. Based on the high risk of disease development and the large flux of persons from HTLV-1 endemic regions, pre-transplant HTLV-1 testing should be mandatory in Spain.