Experience With Donors With Positive Serology for Chagas Disease in Liver Transplantation.

Abstract

Introduction: Utilization of marginal donors in liver transplant (LTx) has been one of the options to increase the availability of grafts. Incidence of donors with positive serology for Chagas has varied from 0,4 to 1,1% of the donors pool in Brazil. Despite the possibility of disease transmission to recipients, our policy has been to utilize these grafts in hepatocellular carcinoma (HCC) or in urgent clinical conditions. Purpose: To analyze the results of LTx using donors with positive serology for Chagas. Methods and patients: From Sept/1997 to Dec/2013, 5 grafts with positive serology for Chagas disease were transplanted into 5 recipients with negative serology for that disease. Donors and recipients demographic date, waiting time on list (WTL), LTx indicators, patient survival and Chagas disease transmission incidence were analyzed. Serologies for Chagas were collected every 15 days in the first 3 months following the LTx, and monthly after for one year, or if recipients showed any symptom of acute Chagas disease. Results: All 5 recipients were male, age and weight ranging from 44-59 yrs and 74-86 kg, respectively, and WTL (days): 20 -1006. Donors age ranged from 48-72yrs, TGP: 13-69(U/L), Sodium: 142 -170 mMol/L, days on UTI: 3-8. All patients underwent LTx due to cirrhosis and hepatocarcinoma, except for one patient who needed urgent LTx due to acute hepatic artery thrombosis. One patient presented acute Chagas disease 6 months after LTx with good evolution after clinical treatment. 3 patients died after LTx; 1 due to bacterian meningitis (following use of OKT3 for treating steroid-resistant acute rejection) and 2 due to HCC recurrence at 22 and 48 months. The other 2 patients are alive at 9 and 10 years after LTx. Conclusion: Despite the small number of cases (n=5) of LTx using grafts with positive serology for Chagas disease, only 1 patient developed acute Chagas disease with good evolution after clinical treatment. From these still incipient results, our recommendation is that these grafts don't be automatically discarded and be destined preferably to recipients with tumors or in urgent LTx.