Progressive multifocal leukoencephalopathy after liver transplantation can have favorable or unfavorable outcome

Area of Science:

• Neuroscience
• Virology
• Immunology

Background:

• Progressive multifocal leukoencephalopathy (PML) is a serious demyelinating disease affecting the central nervous system.
• PML is caused by the JC polyomavirus (JCPyV), primarily in immunocompromised individuals, including solid organ transplant recipients.

Observation:

• This report details two cases of late-onset PML occurring 144 and 204 months post-liver transplantation.
• The clinical presentation of PML involves rapid neurological decline and characteristic white matter lesions on MRI.

Findings:

• There is no specific antiviral treatment for JCPyV, leading to a poor prognosis.
• Restoring the immune response by reducing immunosuppression is the cornerstone of treatment for transplant patients.
• One patient survived 3 years post-diagnosis after complete immunosuppression withdrawal, while another died 26 months post-diagnosis due to severe rejection during immunosuppression tapering.

Implications:

• These findings highlight the critical role of immune reconstitution in managing PML in liver transplant recipients.
• Careful management of immunosuppression is essential to balance the risk of PML with the prevention of organ rejection.
• Further research into JCPyV pathogenesis and treatment strategies is warranted for this vulnerable patient population.