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

AbstractBACKGROUND:
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.
AuthorsMichael R Marvin, Guy N Brock, Kwadwo Kwarteng, Ravi Nagubandi, Kadiyala V Ravindra, Mary Eng, Joseph F Buell
JournalTransplantation (Transplantation) Vol. 87 Issue 8 Pg. 1180-90 (Apr 27 2009) ISSN: 1534-6080 [Electronic] United States
PMID19384165 (Publication Type: Journal Article, Research Support, N.I.H., Extramural)
Topics
  • Adult
  • Aged
  • Deltaretrovirus Infections (epidemiology)
  • Ethnic Groups
  • 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)

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