title: 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).
  
  
  CONCLUSIONS
  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.affiliation: Department of Surgery, Division of Transplantation, University of Louisville, Louisville, KY, USA. Michael.marvin@jhsmh.org
authors.forename: Michael R
authors.initials: MR
authors.lastname: Marvin
authors.forename: Guy N
authors.initials: GN
authors.lastname: Brock
authors.forename: Kwadwo
authors.initials: K
authors.lastname: Kwarteng
authors.forename: Ravi
authors.initials: R
authors.lastname: Nagubandi
authors.forename: Kadiyala V
authors.initials: KV
authors.lastname: Ravindra
authors.forename: Mary
authors.initials: M
authors.lastname: Eng
authors.forename: Joseph F
authors.initials: JF
authors.lastname: Buell
mesh_terms: D000328:Adult; D000368:Aged; D006800:Deltaretrovirus Infections / Q000453:epidemiology*; D005006:Ethnicity; D005189:False Positive Reactions; D005260:Female; D006085:Graft Survival; D003698:Hepatitis Delta Virus; D006801:Humans; D016031:Liver Transplantation / Q000401:mortality / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012449:Safety; D015996:Survival Rate; D017741:Survivors / Q000706:statistics & numerical data*; D014019:Tissue Donors / Q000706:statistics & numerical data*; D014412:Tumor Virus Infections / Q000453:epidemiology / Q000401:mortality