Renal transplantation in patients with human T-cell lymphotropic virus type 1.
BACKGROUND
Renal transplantation (RTx) in carriers of human T-cell lymphotropic virus type 1 (HTLV-1) has a risk of developing overt leukemia upon immunosuppression. Although there have been a few reports of such cases, it is unclear HTLV-1 carrier if patients on the modern immunosuppressants would develop HTLV-1-associated myelopathy or adult T-cell leukemia lymphoma.


METHODS
We retrospectively reviewed the clinical outcomes of RTx in nine HTLV-1 carriers to assess a risk of developing leukemia from 2002 to 2011 using immunosuppression with a calcineurin inhibitor, mycophenolate mofetil (MMF), and steroid. The anti-CD25 monoclonal antibody basiliximab was used for induction. In two cases of ABO-incompatible RTx, the rituximab was also administered before RTx.


RESULTS
The ratio of male to female subjects was 2 to 7 with an overall mean recipient age of 54.3 ± 8.1 years. We prescribed cyclosporine (n = 5) or tacrolimus (n = 4). There was only one graft loss due to the death caused by aspiration pneumonia with a functioning graft. No one developed overt leukemia with combined treatment with MMF, basiliximab and rituximab.


CONCLUSIONS
We concluded that RTx in HTLV-1 carriers could be performed using a modern immunosuppressive regimen, without the risk of developing leukemia.
Department of Surgery III, Tokyo Women's Medical University, Tokyo, Japan.
H
H
Shirai
M
M
Suzuki
Y
Y
Tomita
K
K
Iwadoh
K
K
Kai
A
A
Sannomiya
I
I
Koyama
I
I
Nakajima
S
S
Fuchinoue
D000368:Aged; D004359:Drug Therapy, Combination; D005260:Female; D006085:Graft Survival; D015490:HTLV-I Infections / Q000150:complications* / Q000175:diagnosis / Q000401:mortality; D015368:Human T-lymphotropic virus 1 / Q000302:isolation & purification / Q000472:pathogenicity*; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage* / Q000009:adverse effects; D007564:Japan; D016030:Kidney Transplantation / Q000009:adverse effects / Q000401:mortality; D015459:Leukemia-Lymphoma, Adult T-Cell / Q000209:etiology; D008297:Male; D008875:Middle Aged; D015493:Paraparesis, Tropical Spastic / Q000209:etiology; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome; D014775:Virus Activation
D007166:Immunosuppressive Agents