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Ann Hepatol. 2019 Mar - Apr;18(2):397-401. doi: 10.1016/j.aohep.2018.06.002. Epub 2019 Apr 17.

Myelopathy due to human T-cell leukemia virus type-1 from the donor after ABO-incompatible liver transplantation.

Author information

1
Department of Surgery, Keio University School of Medicine, Tokyo, Japan.
2
Department of Surgery, Keio University School of Medicine, Tokyo, Japan. Electronic address: obara.z3@keio.jp.
3
Department of Neurology, Keio University School of Medicine, Tokyo, Japan.
4
Department of Pediatric Surgery, Keio University School of Medicine, Tokyo, Japan.
5
Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan.
6
Department of Transplantation and Pediatric Surgery, Kumamoto University, Kumamoto, Japan.
7
Department of Hepato-Biliary-Pancreatic and Gastrointestinal Surgery, International University of Health and Welfare School of Medicine, Chiba, Japan.

Abstract

We report the case of a 53-year-old-man who developed human T-cell leukemia virus type-1-associated myelopathy (HAM) after ABO-incompatible liver transplantation for alcoholic liver cirrhosis. The living donor was seropositive for human T-cell leukemia virus type-1 (HTLV-1) and the recipient was seronegative for HTLV-1 before transplantation. After transplantation, the recipient developed steroid-resistant acute cellular rejection, which was successfully treated using anti-thymocyte globulin, and he was eventually discharged. He underwent spinal surgery twice after the transplantation for the treatment of cervical spondylosis that had been present for a period of 9 months before the transplantation. The surgery improved his gait impairment temporarily. However, his gait impairment progressed, and magnetic resonance imaging revealed multiple sites of myelopathy. He was diagnosed with HAM 16 months after the transplantation. Pulse steroid therapy (1000mg) was administered over a period of 3 days, and his limb paresis improved. Presently, steroid therapy is being continued, with a plan to eventually taper the dose, and he is being carefully followed up at our institution. Our case suggests that liver transplantation involving an HTLV-1-positive living donor carries the risk of virus transmission and short-term development of HAM after transplantation.

KEYWORDS:

ABO blood-type barrier; HTLV-1-associated myelopathy; Living-donor liver transplantation; Transmission

PMID:
31029562
DOI:
10.1016/j.aohep.2018.06.002
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