Nationwide questionnaire study on the management of HTLV-1 infection in organ transplantation to reveal the evidence-practice gap

• Published in: Japanese Journal of Transplantation Vol. 56; no. 4; pp. 377 - 387
• Main Authors: YAMAUCHI, Junji, ARAYA, Natsumi, YAGISHITA, Naoko, SATO, Tomoo, YUZAWA, Kenji, YAMANO, Yoshihisa
• Format: Journal Article
• Language: Japanese
• Published: The Japan Society for Transplantation 2021
• Subjects: adult T-cell leukemia/lymphoma; guideline; HTLV-1-associated myelopathy; human T-cell leukemia virus type I; organ transplantation
• ISSN: 0578-7947; 2188-0034
• DOI: 10.11386/jst.56.4_377

【Objective】 To improve the Japanese guideline for HTLV-1 infection in organ transplantation published in 2019, we investigated the awareness of the guideline and actual management in Japan.【Methods】 In February 2020, we sent a questionnaire about the guideline and the actual management of HTLV-1 infection to 220 hospitals in which kidney and/or liver transplantations were performed. Transplant doctors anonymously answered and returned it by mail.【Results】 The questionnaire was returned from 106 (48%) hospitals and 46% of them had already known the guideline. More than 90% supported or were somewhat supportive of the contents of the guideline. The indication policy for an HTLV-1-positive donor to a negative recipient (D+/R−) kidney transplantation, which is contraindicated in the guideline, was: ‘no contraindication,’ 0%; ‘relative contraindication,’ 15%; ‘absolute contraindication,’ 73%; ‘not determined,’ 6%. That of D+/R− liver transplantation, which is not an absolute contraindication, was: ‘no contraindication,’ 0%; ‘relative contraindication,’ 35%; ‘absolute contraindication,’ 35%; ‘not determined,’ 19%. Regarding D+/R+ and D−/R+ transplantations, which are not contraindicated, the answers were similar for kidney and liver: ‘no contraindication,’ ∼50%; ‘relative contraindication,’ ∼10%; ‘absolute contraindication,’∼10%; ‘not determined,’∼20%. Regarding pretransplant HTLV-1 screening, nearly 90% routinely performed the screening test; however, only 48% knew that the confirmatory test is necessary to diagnose HTLV-1 infection.【Conclusion】 Most hospitals agreed with the guideline; however, the indication policies were substantially different, suggesting that D+/R− transplantation sometimes cannot be avoided because of the donor shortage. Doctors also had concern about the safety of transplantation for HTLV-1-positive recipients. More evidence is required for this patient population.