Reactivation of Chagas disease among heart transplant recipients in the United States, 2012-2016. Transpl Infect Dis 2018 Dec;20(6):e12996
Date
09/12/2018Pubmed ID
30204269Pubmed Central ID
PMC6289649DOI
10.1111/tid.12996Scopus ID
2-s2.0-85054302525 (requires institutional sign-in at Scopus site) 51 CitationsAbstract
BACKGROUND: Heart transplantation has been shown to be a safe and effective intervention for progressive cardiomyopathy from chronic Chagas disease. However, in the presence of the immunosuppression required for heart transplantation, the likelihood of Chagas disease reactivation is significant. Reactivation may cause myocarditis resulting in allograft dysfunction and the rapid onset of congestive heart failure. Reactivation rates have been well documented in Latin America; however, there is a paucity of data regarding the risk in non-endemic countries.
METHODS: We present our experience with 31 patients with chronic Chagas disease who underwent orthotopic heart transplantation in the United States from 2012 to 2016. Patients were monitored following a standard schedule.
RESULTS: Of the 31 patients, 19 (61%) developed evidence of reactivation. Among the 19 patients, a majority (95%) were identified by laboratory monitoring using polymerase chain reaction testing. One patient was identified after the onset of clinical symptoms of reactivation. All subjects with evidence of reactivation were alive at follow-up (median: 60 weeks).
CONCLUSIONS: Transplant programs in the United States are encouraged to implement a monitoring program for heart transplant recipients with Chagas disease. Our experience using a preemptive approach of monitoring for Chagas disease reactivation was effective at identifying reactivation before symptoms developed.
Author List
Gray EB, La Hoz RM, Green JS, Vikram HR, Benedict T, Rivera H, Montgomery SPMESH terms used to index this publication - Major topics in bold
AdultAged
Allografts
Chagas Cardiomyopathy
Female
Follow-Up Studies
Heart
Heart Failure
Heart Transplantation
Humans
Male
Middle Aged
Myocardium
Recurrence
Risk Factors
Trypanosoma cruzi
United States
