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

Abstract

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.

• Authors: Michael R Marvin, Guy N Brock, Kwadwo Kwarteng, Ravi Nagubandi, Kadiyala V Ravindra, Mary Eng, Joseph F Buell
• Journal: Transplantation (Transplantation) Vol. 87 Issue 8 Pg. 1180-90 (Apr 27 2009) ISSN: 1534-6080 [Electronic] United States
• PMID: 19384165 (Publication Type: Journal Article, Research Support, N.I.H., Extramural)

Topics

• Adult
• Aged
• Deltaretrovirus Infections (epidemiology)
• Ethnicity
• 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)