Comparative Survival Analysis Between Azathioprine and Mykophenolate in Chagasic Patients Undergoing Heart Transplantation

Abstract

PurposeChagas' cardiomyopathy is considered an aggressive etiology of heart failure(HF).When evolving to advanced HF, the gold standard treatment is heart transplantation (HT).The immunosuppressive therapy used in HT may facilitate infectious complications, including the reactivation of Chagas disease(CD).Bacal et al demonstrated lower rates of chagasic reactivation with azathioprine compared to mycophenolate. However, studies in HT of non-chagasic patients revealed superiority of mycophenolate in relation to rejection and survival. The present study aims to assess the survival of chagasic patients using mycofenolate compared to azathioprine.MethodsRetrospective observational study that evaluated HT patients due to CD between 2003 and 2020.Patients who died before discharge and who suspended the use of antiproliferatives were excluded. Patients were divided into two groups (Azathioprine x Mycofenolate) based on the most recent immunosuppressive regimen. The difference between groups was tested in quantitative variables using Mann-Whitney test. For categorical variables, the Fisher and Wilcoxon tests were used. Survival were analysed by Kaplan-Mayer and Log-Rank.Results20 patients were evaluated in the Azathioprine group and 54 in the Mycophenolate group. The study population had a median age of 50 years, male predominance(56,7%), white race(60,8%) and all using calcineurin inhibitors,73% using tacrolimus and 27% using cyclosporine. As for the baseline characteristics, there was no difference between the groups. As for the survival analysis, as shown in the Kaplan-Mayer curves, there was no difference between the groups.ConclusionThere was no difference in survival when compared to immunosuppression between Azathioprine X Mykophenolate in chagasic transplant patients, suggesting that there is no preference for an antiproliferative in chagasic transplant patients. Further studies are needed to corroborate this fact. Chagas' cardiomyopathy is considered an aggressive etiology of heart failure(HF).When evolving to advanced HF, the gold standard treatment is heart transplantation (HT).The immunosuppressive therapy used in HT may facilitate infectious complications, including the reactivation of Chagas disease(CD).Bacal et al demonstrated lower rates of chagasic reactivation with azathioprine compared to mycophenolate. However, studies in HT of non-chagasic patients revealed superiority of mycophenolate in relation to rejection and survival. The present study aims to assess the survival of chagasic patients using mycofenolate compared to azathioprine. Retrospective observational study that evaluated HT patients due to CD between 2003 and 2020.Patients who died before discharge and who suspended the use of antiproliferatives were excluded. Patients were divided into two groups (Azathioprine x Mycofenolate) based on the most recent immunosuppressive regimen. The difference between groups was tested in quantitative variables using Mann-Whitney test. For categorical variables, the Fisher and Wilcoxon tests were used. Survival were analysed by Kaplan-Mayer and Log-Rank. 20 patients were evaluated in the Azathioprine group and 54 in the Mycophenolate group. The study population had a median age of 50 years, male predominance(56,7%), white race(60,8%) and all using calcineurin inhibitors,73% using tacrolimus and 27% using cyclosporine. As for the baseline characteristics, there was no difference between the groups. As for the survival analysis, as shown in the Kaplan-Mayer curves, there was no difference between the groups. There was no difference in survival when compared to immunosuppression between Azathioprine X Mykophenolate in chagasic transplant patients, suggesting that there is no preference for an antiproliferative in chagasic transplant patients. Further studies are needed to corroborate this fact.