Later Evolution After Cardiac Transplantation in Chagas’ Disease

• Published in: Transplantation proceedings Vol. 37; no. 6; pp. 2793 - 2798
• Main Authors: Fiorelli, A.I., Stolf, N.A.G., Honorato, R., Bocchi, E., Bacal, F., Uip, D., Strabelli, T., Issa, V., Amato, V.A., Fiorelli, L.R., Oliveira, S.A.
• Format: Journal Article Conference Proceeding
• Language: English
• Published: New York, NY Elsevier Inc 01.07.2005; Elsevier Science
• Subjects: Adrenal Cortex Hormones - therapeutic use; Biological and medical sciences; Cardiomyopathies - parasitology; Cardiomyopathies - surgery; Cause of Death; Chagas Disease - complications; Cyclosporine - therapeutic use; Fundamental and applied biological sciences. Psychology; Fundamental immunology; Heart Transplantation - immunology; Heart Transplantation - mortality; Heart Transplantation - physiology; Human protozoal diseases; Humans; Immunosuppressive Agents - therapeutic use; Infectious diseases; Medical sciences; Parasitic diseases; Protozoal diseases; Retrospective Studies; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Survival Analysis; Tissue, organ and graft immunology; Trypanosomiasis; Heart; Protozoal disease; Chagas disease; Cardiovascular disease; Transplantation; Parasitosis; Homotransplantation; Infection; Medicine; Treatment; Surgery; Heart disease; Evolution; Graft; Circulatory system; Trypanosomiasis
• ISSN: 0041-1345; 1873-2623
• DOI: 10.1016/j.transproceed.2005.05.038

This research reported the accumulated experience with cardiac transplantation in Chagas’ disease, emphasizing reactivation, immunosuppression, and mortality. Fifty-nine patients undergoing cardiac transplantation had Chagas’ disease with classically accepted recipient selection criteria. In this series, 84.7% of the patients were functional class IV; 36.0% used vasopressor support; and 13.5% mechanical circulatory assistance. One patient received a heart and kidney transplantation. After the initial experience the doses of immunosuppressiants were significantly reduced with improvement in outcomes. The diagnosis of the reactivation of disease was documented by the identification of parasite in the myocardium, or on subcutaneous or serological exams. Reactivation of disease was significantly reduced by decreasing the immunosuppression. Immediate mortality occurred in 10 cases: three infections, two allograft dysfunction, two rejections, and two sudden deaths. Subsequent mortality happened in 14 patients: four by lymphoma, three by infection, two by Kaposi’s sarcoma two by rejection, two by constrictive pericarditis, and one by reactivation of disease in the brain. There’s no correlation between the disease and pre- or postoperative prophylaxis. The early diagnosis and specific treatment of reactivation did not leave functional sequelae in the myocardium. Reduction in immunosuppression significantly reduced reactivation of disease and neoplasms. The combined transplantation can be realized safely with more care about the immunosuppressants.