Progressive multifocal leukoencephalopathy in transplant recipients

Farrah J. Mateen, Rajanandini Muralidharan, Marco Carone, Diederik Van De Beek, Daniel M. Harrison, Allen Jr. Aksamit, Mary S. Gould, David B. Clifford, Avindra Nath

Research output: Contribution to journalArticle

100 Citations (Scopus)

Abstract

Objective: Transplant recipients are at risk of developing progressive multifocal leukoencephalopathy (PML), a rare demyelinating disorder caused by oligodendrocyte destruction by JC virus. Methods: Reports of PML following transplantation were found using PubMed Entrez (1958-July 2010). A multicenter, retrospective cohort study also identified all cases of PML among transplant recipients diagnosed at Mayo Clinic, Johns Hopkins University, Washington University, and Amsterdam Academic Medical Center. At 1 institution, the incidence of posttransplantation PML was calculated. Results: A total of 69 cases (44 solid organ, 25 bone marrow) of posttransplantation PML were found including 15 from the 4 medical centers and another 54 from the literature. The median time to development of first symptoms of PML following transplantation was longer in solid organ vs bone marrow recipients (27 vs 11 months, p = 0.0005, range of <1 to >240). Median survival following symptom onset was 6.4 months in solid organ vs 19.5 months in bone marrow recipients (p = 0.068). Case fatality was 84% (95% confidence interval [CI], 70.3-92.4%) and survival beyond 1 year was 55.7% (95% CI, 41.2-67.2%). The incidence of PML among heart and/or lung transplant recipients at 1 institution was 1.24 per 1,000 posttransplantation person-years (95% CI, 0.25-3.61). No clear association was found with any 1 immunosuppressant agent. No treatment provided demonstrable therapeutic benefit. Interpretation: The risk of PML exists throughout the posttransplantation period. Bone marrow recipients survive longer than solid organ recipients but may have a lower median time to first symptoms of PML. Posttransplantation PML has a higher case fatality and may have a higher incidence than reported in human immunodeficiency virus (HIV) patients on highly-active antiretroviral therapy (HAART) or multiple sclerosis patients treated with natalizumab.

Original languageEnglish (US)
Pages (from-to)305-322
Number of pages18
JournalAnnals of Neurology
Volume70
Issue number2
DOIs
StatePublished - Aug 1 2011

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Progressive Multifocal Leukoencephalopathy
Bone Marrow
Confidence Intervals
Incidence
Transplantation
Transplant Recipients
JC Virus
Survival
Oligodendroglia
Highly Active Antiretroviral Therapy
Demyelinating Diseases
Immunosuppressive Agents
PubMed
Multiple Sclerosis
Cohort Studies
Retrospective Studies
HIV

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology

Cite this

Mateen, F. J., Muralidharan, R., Carone, M., Van De Beek, D., Harrison, D. M., Aksamit, A. J., ... Nath, A. (2011). Progressive multifocal leukoencephalopathy in transplant recipients. Annals of Neurology, 70(2), 305-322. https://doi.org/10.1002/ana.22408

Progressive multifocal leukoencephalopathy in transplant recipients. / Mateen, Farrah J.; Muralidharan, Rajanandini; Carone, Marco; Van De Beek, Diederik; Harrison, Daniel M.; Aksamit, Allen Jr.; Gould, Mary S.; Clifford, David B.; Nath, Avindra.

In: Annals of Neurology, Vol. 70, No. 2, 01.08.2011, p. 305-322.

Research output: Contribution to journalArticle

Mateen, FJ, Muralidharan, R, Carone, M, Van De Beek, D, Harrison, DM, Aksamit, AJ, Gould, MS, Clifford, DB & Nath, A 2011, 'Progressive multifocal leukoencephalopathy in transplant recipients', Annals of Neurology, vol. 70, no. 2, pp. 305-322. https://doi.org/10.1002/ana.22408
Mateen FJ, Muralidharan R, Carone M, Van De Beek D, Harrison DM, Aksamit AJ et al. Progressive multifocal leukoencephalopathy in transplant recipients. Annals of Neurology. 2011 Aug 1;70(2):305-322. https://doi.org/10.1002/ana.22408
Mateen, Farrah J. ; Muralidharan, Rajanandini ; Carone, Marco ; Van De Beek, Diederik ; Harrison, Daniel M. ; Aksamit, Allen Jr. ; Gould, Mary S. ; Clifford, David B. ; Nath, Avindra. / Progressive multifocal leukoencephalopathy in transplant recipients. In: Annals of Neurology. 2011 ; Vol. 70, No. 2. pp. 305-322.
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