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Saudi Journal of Kidney Diseases and Transplantation
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ORIGINAL ARTICLE  
Year : 2011  |  Volume : 22  |  Issue : 4  |  Page : 670-674
Prognosis of HTLV-1 positive renal transplant recipients in Iran


Nephrology Ward, Department of Internal Medicine, Imam Reza Hospital, Mashhad University of Medical Sciences (MUMS), Mashhad, I. R. Iran

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Date of Web Publication9-Jul-2011
 

   Abstract 

The human T lymphocyte virus-1 (HTLV-1) is the responsible pathogen for diseases such as HTLV-1 associated myelopathy (HAM) and adult T-cell leukemia (ATL). Mashhad, in northeast Iran, with high instances of this infection, has a noticeable number of infected renal failure patients. Since immunosuppressive drugs might decrease the latency period of HTLV-1 or increase its complications, the question arises whether HTLV-1 positive renal failure patients are suitable candidates for kidney transplants. To answer this, HTLV-1 positive recipients were evaluated in our study. Patients were divided into two groups. First group consisted of patients at the Imam Reza Hospital dialysis center. Second group had 20 kidney transplantation recipients consisting of ten infected and ten uninfected recipients as control from Imam Reza. Medical history of these patients was recorded and evaluated. The follow-up periods were between one and six years. Among them, 3.8% of patients undergoing dialysis were infected. The most important fact resulting from this study is that none of the infected recipients suffered from HAM or ATL during the follow-up period. In addition, it did not show any significant difference in the incidence of post-transplant complications between the infected and non-infected groups. Our study indicates that HTLV-1 positive patients may undergo kidney transplant without fear of increased incidence of side effects than those found in uninfected recipients. Because of short-term follow-up, probable long latency period of the virus, and the limited number of infected recipients, further work on this issue would be prudent.

How to cite this article:
Naghibi O, Nazemian F, Naghibi M, Ali Javidi D B. Prognosis of HTLV-1 positive renal transplant recipients in Iran. Saudi J Kidney Dis Transpl 2011;22:670-4

How to cite this URL:
Naghibi O, Nazemian F, Naghibi M, Ali Javidi D B. Prognosis of HTLV-1 positive renal transplant recipients in Iran. Saudi J Kidney Dis Transpl [serial online] 2011 [cited 2019 Nov 13];22:670-4. Available from: http://www.sjkdt.org/text.asp?2011/22/4/670/82642

   Introduction Top


Human T lymphocyte virus-1 (HTLV-1) is the pathogen responsible for diseases such as HTLV-1 associated myelopathy (HAM) and adult T-cell leukemia (ATL) and has a long latency period. Modes of transmission include from mother to child, through blood transfusion, sexual contact, and also, organ transplant. [1] Though found worldwide, the prevalence of HTLV-1 varies among countries. In Japan and parts of South America and Africa, it is much more common. Mashhad, in northeast Iran, is one area where a high prevalence of infection has been reported, i.e. around 77% among blood donors. [2]

As a result, there are a considerable number of renal failure patients infected by HTVL-1. Since immunosuppressive drugs prescribed for kidney transplant recipients might decrease the latency period of HTLV-1 or increase its other possible complications, the question arises whether HTLV-1 positive renal failure patients are suitable candidates for kidney transplants. We conducted this study to answer some of these questions at least partially.


   Material and Methods Top


In this study, two groups of patients were considered. First group consisted of patients on dialysis at the Imam Reza Hospital dialysis center to assess the frequency of HTLV-1 positive patients undergoing dialysis. Second group consisted of 20 kidney transplantation recipients, 10 infected and 10 non-infected (as controls), whose surgeries were performed between 2001 and 2006. Their medical history was retrospectively studied.

The information collected about the recipients included age at operation, gender, immunosuppressive drugs used, period of kidney function (PKF), creatinine level in first, third and fifth year after operation, donor type (live related, cadaver or live unrelated), evidence of HTLV-1 infection (in donors and recipients), period after transplantation operation (PAT), occurrence of ATL or HAM and other infections that occurred after transplantation.

The study was performed in accordance with the Declaration of Helsinki and approved by the ethics committee at Mashhad University of Medical Sciences. Written, informed consents were obtained from patients before beginning the study.


   Results Top


The information of infected and non-infected recipients are given in [Table 1] and [Table 2] respectively. Among the infected recipients, there were two cases of transplants from positive donors to positive recipients (number 4, 7). In both the cases, the donors were family members of the recipients. In all other cases, donors were negative. The follow-up periods were between one and six years.
Table 1: The information of infected recipients.

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Table 2: The information of non-infected recipients.

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As immunosuppressive drugs play a considerable role on other infections in the recipients, we chose recipients who were basically on the same immunosuppressive drugs.

One of the patients (number 3) underwent a second transplantation due to chronic allograft nephropathy (CAN) after 89 months. The data presented are from the second transplant. Regarding the frequency of infected patients under dialysis, five patients from a total of 76 patients on dialysis were infected (around 3.8%). The most important finding of this study is that none of the infected recipients suffered from HAM or ATL.


   Discussion Top


The HTLV-1 found all over the world can be transmitted in different ways including sexual contact, from mother to child, through blood transfusion and organ transplant. The report on the transmission of HTLV-1 through kidney and liver transplant in Spain is a good example of organ transplant transmission. [3],[4],[5]

Among areas with a high prevalence of this virus, Japan and some areas in Latin America rank high. [1] Mashhad, in northeast Iran, is another area where infection is common. [2],[6],[7] This, in turn, leads to a greater number of endstage kidney disease patients with the HTLV-1 infection. In this study, we also assessed the number of such patients under dialysis in our center. Our results show the frequency of infected patients on dialysis as 3.8%. One interesting point which can indicate both the severity and prevalence of this virus is the fact that even immigrant Jews from Mashhad to Israel have a higher infection rate when compared to other ethnic clusters there. [8],[9]

Naturally, these infected patients also become candidates for kidney transplantation. In this case, two important issues are to be appraised. First, whether the infected recipients are prone to have a shortened latency period of the virus or an exacerbation of viral activity. Second is the question of whether these patients suffer from complications related to transplantation more than the uninfected recipients. Our study was designed to answer these questions at least partially.

As presented in [Table 1] and [Table 2], the diseases caused by HLTV-1 did not occur after transplantation among infected recipients. This may be due to a long latency period and short period of follow-up. A longer period of follow-up is needed to study the occurrence of HTLV-1 related diseases and their severity compared to that of infected patients who did not undergo transplantation. A main factor contributing to the chance of increased viral activity in transplant recipients, viz., immunosuppressive drugs, was for the most part same in all the recipients.

Considering its high HTLV-1 infection rate, Japan serves as a suitable model for comparison with Mashhad. In the same study conducted in Japan, with the identical immunosuppressive drugs, kidney transplant did not result in an increased occurrence of diseases caused by this virus, though the follow-ups were carried on for longer periods. [10]

To compare the transplant complications between infected and uninfected recipients, level of creatinine and rate of rejection were assessed [Table 1] and [Table 2]. To present a glimpse of the condition, we chose a control group with the most similarities in the "period after transplantation" and the use of immunosuppressive drugs. In the tables, patients who suffered from rejection are marked with "R". To have a basis for comparing the rejection rate between infected and uninfected patients, we offer rejection rate in our center for recipients generally (both infected and uninfected recipients): first year, 12.5%; third year, 85.5%; fifth year, 65.7%.

The presence of other infections in recipients was also assessed. Our results did not indicate any significant difference between these two groups. Due to the limited number of infected patients, statistical analysis may prove to be inconclusive. Thus, considering the great variety of infections possible and the limited number of infected recipients in this study, definitive conclusions are difficult and we feel that a future study with larger number of infected recipients is needed. As the number of infected recipients increases, something which the high prevalence of virus in our area makes probably inevitable, we should be able to make broader appraisal of these issues with a larger number of patients.

In conclusion, the available information from this study shows that HTLV-1 positive patients may undergo kidney transplant without fear of having any more side effects than uninfected recipients. However, because of the short-term ollow-up, probable long latency period of the virus, and the limited number of infected recipients, it is prudent, however, to work further on this issue to achieve more accurate results.

 
   References Top

1.Verdonck K, González E, Van Dooren S. Human T-lymphotropic virus 1: recent knowledge about an ancient infection. Lancet Infect Dis 2007; 7(4):266-81.  Back to cited text no. 1
    
2.Abbaszadegan MR, Gholamin M, Tabatabaee A. Prevalence of human T-lymphotropic virus type 1 among blood donors from Mashhad, Iran. J Clin Microbiol 2003;41(6):2593-5.  Back to cited text no. 2
    
3.Farid R, Houshmand M, Abbaszadegan M. González-Pérez MP, Muñoz-Juárez L, Cárdenas FC. Human T-cell leukemia virus type I infection in various recipients of transplants from the same donor. Transplantation 2003;75(7): 1006-11.  Back to cited text no. 3
    
4.Toro C, Rodés B, Poveda E. Rapid development of subacute myelopathy in three organ transplant recipients after transmission of human T-cell lymphotropic virus type I from a single donor. Transplantation 2003;75(1):1-2.  Back to cited text no. 4
    
5.Villafruela Mateos A, Arruza Echevarría A, Martín Bazaco J. HTLV infection after renal transplant. Arch Esp Urol 2005;58(10):1064-8.  Back to cited text no. 5
    
6.Sabouri AH, Saito M, Usuku K. Differences in viral and host genetic risk factors for development of human T-cell lymphotropic virus type 1 (HTLV-1)-associated myelopathy/tropical spastic paraparesis between Iranian and Japanese HTLV-1-infected individuals. J Gen Virol 2005;86(Pt 3):773-81.  Back to cited text no. 6
    
7.Voevodin A, Gessain A. Common origin of human T-lymphotropic virus type-I from Iran, Kuwait, Israel, and La Réunion. Island. J Med Virol 1997;52(1):77-82.  Back to cited text no. 7
    
8.Achiron A, Pinhas-Hamiel O, Doll L. Spastic paraparesis associated with human T-lymphotropic virus type I: a clinical, serological, and genomic study in Iranian-born Mashhadi Jews. Ann Neurol 1993;34(5):670-5.   Back to cited text no. 8
    
9.Miller M, Achiron A, Shaklai M. Ethnic cluster of HTLV-I infection in Israel among the Mashhadi Jewish Population. J Med Virol 1998;56(3):269-74.   Back to cited text no. 9
    
10.Nakamura N, Tamaru S, Ohshima K. Prognosis of HTLV-I-Positive Renal Transplant Recipients. Transplant Proc 2005;37:1779-82.  Back to cited text no. 10
    

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Correspondence Address:
Fatemeh Nazemian
Nephrology Ward, Department of Internal Medicine, Imam Reza Hospital, Mashad University of Medical Sciences (MUMS), Mashad
I. R. Iran
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PMID: 21743209

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    Abstract
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