Long-Term Survival Outcomes after Heart Transplantation in Patients with Chagas Cardiomyopathy

Abstract

We report the long-term survival of heart transplant (HT) patients with a diagnosis of Chagas cardiomyopathy. The UNOS database was queried for HT candidates with a pre-transplant diagnosis of Chagas cardiomyopathy (1987-2019). Post-HT survival was followed over the ensuing 120 months. Demographics, comorbidities, hemodynamics were compared using standard statistical methods. Multivariate Cox-proportional hazard regression analysis (adjusted for age, sex, diabetes, ethnicity, ischemic time, dialysis, life support and HLA mismatch) was also performed for survival analysis. 38 patients with Chagas cardiomyopathy received HT. The Chagas group tended to be older recipients (Mean 52.6 ± 8.2 vs. 46.7 ± 19.2 years, p=0.053) and have older donors (Mean 28.2 ± 14.0 vs. 32.4 ± 11.2 years, p=0.063). Ethnic composition was significantly different (p<0.001) between the two groups, with Hispanic patients accounting for 92.1% of transplanted Chagas patients. While Chagas patients were more likely to have required VAD support prior to HT (p=0.001), there were no differences in patient waitlist time or ischemic time. Post-HT overall survival through 120 months was significantly higher in Chagas patients (Figure, p=0.0342). Long-term survival after HT in carefully selected patients with a diagnosis of Chagas cardiomyopathy is shown to be favorable as compared to that of non-Chagas patients. The proportion of patients with this disease may be underestimated and their increased recognition is prudent given the adverse consequences to Chagas reactivation post-HT.