The Journal of Thoracic and Cardiovascular Surgery
Volume 138, Issue 1 , Pages 255-256, July 2009

Transmission of human T-lymphotropic virus type I by bilateral living-donor lobar lung transplantation

  • Satomi Yara, MD, PhD

      Affiliations

    • Department of Medicine and Therapeutics (First Department of Internal Medicine), Control and Prevention of Infectious Diseases, Faculty of Medicine, University of the Ryukyus, Okinawa, Japan
    • ,
  • Jiro Fujita, MD, PhD

      Affiliations

    • Department of Medicine and Therapeutics (First Department of Internal Medicine), Control and Prevention of Infectious Diseases, Faculty of Medicine, University of the Ryukyus, Okinawa, Japan
    • ,
  • Hiroshi Date, MD, PhD

      Affiliations

    • Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
    • Department of Thoracic Surgery, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan

Article Outline

CTSNet classification: 12

 

To the Editor:

Human T-lymphotropic virus type I (HTLV-I) is an etiologic agent for adult T-cell leukemia/lymphoma and HTLV-I–associated myelopathy/tropical spastic paraparesis. Most HTLV-I infections are attributable to transmission from mother to child or to sexual contact later in life, whereas transfusion is perhaps the most efficient mode of viral transmission. Seroprevalence of HTLV-1 among high-risk populations is 10% to 30% in the southern area of Japan, such as Okinawa, and approximately 5% in the Caribbean region compared with 1% in Europe and the United States.

There have been several reports of HTLV-1 transmission in association with organ transplantation (Table 1).1, 2, 3, 4 However, no report describes a transmission of HTLV-1 by lung transplantation. We describe the first case of HTLV-1 transmission from a seropositive donor via lung transplantation.

Table 1. Review of the literature about transmission of human T-lymphotropic virus type I after solid-organ transplantation
First authorYearAge and sexOrganClinical featuresReferences
Remesar2000DaughterKidneyNone1
Nakatsuji200050 MKidneyHTLV-1–associated myelopathy2
Toro200353 F∗KidneySubacute myelopathy3
Toro200355 M†KidneySubacute myelopathy3
Toro200344 F‡LiverSubacute myelopathy3
Zarranz200354 F∗KidneyMyelopathy4
Zarranz200357 M†KidneyMyelopathy4
Zarranz200344 F‡LiverMyelopathy4
Yara200842 FLungNonePresent report

HTLV, Human T-lymphotropic virus type I.

∗, †, ‡The same patients.

A 38-year-old woman had abnormal shadows on a chest x-ray at a healthcare examination. Video-assisted thoracoscopic surgical lung biopsy was performed, and usual interstitial pneumonia was diagnosed. Despite some drug treatments, she had dry cough and dyspnea that gradually worsened. In 2003, at the age of 42 years, she was considered eligible for bilateral living-donor lobar lung transplantation at Okayama University. The patient was negative for anti-HTLV-I antibody. The younger sister was positive less than 16 times for anti-HTLV-I antibody. Because the patient's condition was severe and deteriorating, she was considered to be in urgent need of lung transplantation. In addition, there are no reports of HTLV-I transmission by lung transplantation. Therefore, lung transplantation was performed using lungs from an elder brother and a younger sister in August 2003. Before the transplant, the lungs were flushed with 1 L of Euro-Collins solution, which consists of 115 mmol/L monopotassium, 10 mmol/L sodium, and 3.6% glucose, both antegradely and retrogradely.5

The patient's general condition improved after the lung transplantation. In November 2008, her oxygen saturation was 98% to 99% at room air. However, serologic follow-up demonstrated that she had acquired HTLV-I infection posttransplantation. Antibody titers were as follows: 256 times after 9 months, more than 8192 times in August 2006, 2048 times in April 2008.

Remesar and colleagues1 reported the first case of HTLV-1 infection transmitted by organ transplantation (a child who received a kidney from her infected mother). The seroconversion was observed 83 days after transplantation. Nakatsuji and colleagues2 described a kidney transplant recipient who presented with tropical spastic paraparesis 4 years posttransplantation. Toro and colleagues3 reported the transmission of HTLV-1 from a single donor to 3 organ (2 kidneys and 1 liver) transplant recipients, who subsequently developed tropical spastic paraparesis within 2 years posttransplant.

Although the lungs were pretreated with preservative solution, transmission of HTLV-1 could not be prevented. Approximately 5 years posttransplant, our patient demonstrates neither neurologic nor hematologic evidence of HTLV-I–related disease. However, this patient should be followed up for adult T-cell leukemia/lymphoma and tropical spastic paraparesis.

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References 

  1. Remesar MC, del Pozo AE, Pittis MG, Mangano AM, Sen L, Briones L. Transmission of HTLV-1 by kidney transplant. Transfusion. 2000;40:1421
  2. Nakatsuji Y, Sugai F, Watanabe S, Kaido M, Koguchi K, Abe K, et al. HTLV-I-associated myelopathy manifested after renal transplantation. J Neurol Sci. 2000;177:154–156
  3. Toro C, Rodés B, Poveda E, Soriano V. Rapid development of subacute myelopathy in three organ transplant recipients after transmission of a human T-cell lymphotrophic virus type I from a single donor. Transplantation. 2003;75:102–104
  4. Zarranz Imirizaldu JJ, Gomez Esteban JC, Rouco Axpe I, Perez Concha T, Velasco Juanes F, et al. Post-transplantation HTLV-1 myelopathy in three recipients from a single donor. J Neurol Neurosurg Psychiatry. 2003;74:1080–1084
  5. Date H, Aoe M, Nagahiro I, Sano Y, Andou A, Matsubara H, et al. Living-donor lobar lung transplantation for various lung disease. J Thorac Cardiovasc Surg. 2004;126:476–481

PII: S0022-5223(09)00467-X

doi:10.1016/j.jtcvs.2008.12.050

The Journal of Thoracic and Cardiovascular Surgery
Volume 138, Issue 1 , Pages 255-256, July 2009

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