Heart Transplantation in 107 Cases of Chagas' Disease

Abstract

Introduction Chagas' disease is endemic in South America. Objective This research reviewed the experience with cardiac transplantation in Chagas' disease, emphasizing reactivation, immunosuppression, and mortality. Methods Over 25 years from March 1985 to March 2010, 107/409 (26.2%) patients with Chagas' disease underwent heart transplantation, patients including 74 (71.1%) men and 72 (67.2%), in functional class IV with 33 (30.8%) on vasopressors and 17 (10.7%) on mechanical circulatory support. Results The diagnosis of disease reactivation was performed by identifying the parasite in the myocardium ( n = 23; 71.8%) in the subcutaneous tissue ( n = 8; 25.0%), in blood ( n = 11; 34.3%), or in central nervous tissue ( n = 1; 3.1%). Hospital mortality was 17.7% ( n = 19) due to infection ( n = 6; 31.5%), graft dysfunction ( n = 6; 31.5%), rejection ( n = 4; 21.1%), or sudden death ( n = 2; 10.5%). Late mortality was 27 (25.2%) cases, which were distributed as: rejection ( n = 6; 22.2%), infection ( n = 6; 22.2%), ( n = lymphoma 4; 14.8%), sarcoma ( n = 2; 7.4%), for constrictive pericarditis ( n = 2; 7.4%) reactivation of Chagas' disease in the central nervous system ( n = 1; 7.1%). Conclusions Transplantation in Chagas' disease has peculiar problems that differ from other etiologies due to the possibility of disease reactivation and the increased possibility of emergence of cancers. However, transplantation is the only treatment able to modify the natural progression of the disease in its terminal phase. Early diagnosis and rapid introduction of benzonidazole reverses the histological patterns. Immunosuppression, especially steroids, predisposes to the development of cancer and disease reactivation.