Reactivation of Chagas disease among heart transplant recipients in the United States, 2012‐2016
Background Heart transplantation has been shown to be a safe and effective intervention for progressive cardiomyopathy from chronic Chagas disease. However, in the presence of the immunosuppression required for heart transplantation, the likelihood of Chagas disease reactivation is significant. Reac...
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| Published in | Transplant infectious disease Vol. 20; no. 6; pp. e12996 - n/a |
|---|---|
| Main Authors | , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
Denmark
Wiley Subscription Services, Inc
01.12.2018
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| Abstract | Background
Heart transplantation has been shown to be a safe and effective intervention for progressive cardiomyopathy from chronic Chagas disease. However, in the presence of the immunosuppression required for heart transplantation, the likelihood of Chagas disease reactivation is significant. Reactivation may cause myocarditis resulting in allograft dysfunction and the rapid onset of congestive heart failure. Reactivation rates have been well documented in Latin America; however, there is a paucity of data regarding the risk in non‐endemic countries.
Methods
We present our experience with 31 patients with chronic Chagas disease who underwent orthotopic heart transplantation in the United States from 2012 to 2016. Patients were monitored following a standard schedule.
Results
Of the 31 patients, 19 (61%) developed evidence of reactivation. Among the 19 patients, a majority (95%) were identified by laboratory monitoring using polymerase chain reaction testing. One patient was identified after the onset of clinical symptoms of reactivation. All subjects with evidence of reactivation were alive at follow‐up (median: 60 weeks).
Conclusions
Transplant programs in the United States are encouraged to implement a monitoring program for heart transplant recipients with Chagas disease. Our experience using a preemptive approach of monitoring for Chagas disease reactivation was effective at identifying reactivation before symptoms developed. |
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| AbstractList | Heart transplantation has been shown to be a safe and effective intervention for progressive cardiomyopathy from chronic Chagas disease. However, in the presence of the immunosuppression required for heart transplantation, the likelihood of Chagas disease reactivation is significant. Reactivation may cause myocarditis resulting in allograft dysfunction and the rapid onset of congestive heart failure. Reactivation rates have been well documented in Latin America; however, there is a paucity of data regarding the risk in non-endemic countries.BACKGROUNDHeart transplantation has been shown to be a safe and effective intervention for progressive cardiomyopathy from chronic Chagas disease. However, in the presence of the immunosuppression required for heart transplantation, the likelihood of Chagas disease reactivation is significant. Reactivation may cause myocarditis resulting in allograft dysfunction and the rapid onset of congestive heart failure. Reactivation rates have been well documented in Latin America; however, there is a paucity of data regarding the risk in non-endemic countries.We present our experience with 31 patients with chronic Chagas disease who underwent orthotopic heart transplantation in the United States from 2012 to 2016. Patients were monitored following a standard schedule.METHODSWe present our experience with 31 patients with chronic Chagas disease who underwent orthotopic heart transplantation in the United States from 2012 to 2016. Patients were monitored following a standard schedule.Of the 31 patients, 19 (61%) developed evidence of reactivation. Among the 19 patients, a majority (95%) were identified by laboratory monitoring using polymerase chain reaction testing. One patient was identified after the onset of clinical symptoms of reactivation. All subjects with evidence of reactivation were alive at follow-up (median: 60 weeks).RESULTSOf the 31 patients, 19 (61%) developed evidence of reactivation. Among the 19 patients, a majority (95%) were identified by laboratory monitoring using polymerase chain reaction testing. One patient was identified after the onset of clinical symptoms of reactivation. All subjects with evidence of reactivation were alive at follow-up (median: 60 weeks).Transplant programs in the United States are encouraged to implement a monitoring program for heart transplant recipients with Chagas disease. Our experience using a preemptive approach of monitoring for Chagas disease reactivation was effective at identifying reactivation before symptoms developed.CONCLUSIONSTransplant programs in the United States are encouraged to implement a monitoring program for heart transplant recipients with Chagas disease. Our experience using a preemptive approach of monitoring for Chagas disease reactivation was effective at identifying reactivation before symptoms developed. Background Heart transplantation has been shown to be a safe and effective intervention for progressive cardiomyopathy from chronic Chagas disease. However, in the presence of the immunosuppression required for heart transplantation, the likelihood of Chagas disease reactivation is significant. Reactivation may cause myocarditis resulting in allograft dysfunction and the rapid onset of congestive heart failure. Reactivation rates have been well documented in Latin America; however, there is a paucity of data regarding the risk in non‐endemic countries. Methods We present our experience with 31 patients with chronic Chagas disease who underwent orthotopic heart transplantation in the United States from 2012 to 2016. Patients were monitored following a standard schedule. Results Of the 31 patients, 19 (61%) developed evidence of reactivation. Among the 19 patients, a majority (95%) were identified by laboratory monitoring using polymerase chain reaction testing. One patient was identified after the onset of clinical symptoms of reactivation. All subjects with evidence of reactivation were alive at follow‐up (median: 60 weeks). Conclusions Transplant programs in the United States are encouraged to implement a monitoring program for heart transplant recipients with Chagas disease. Our experience using a preemptive approach of monitoring for Chagas disease reactivation was effective at identifying reactivation before symptoms developed. BackgroundHeart transplantation has been shown to be a safe and effective intervention for progressive cardiomyopathy from chronic Chagas disease. However, in the presence of the immunosuppression required for heart transplantation, the likelihood of Chagas disease reactivation is significant. Reactivation may cause myocarditis resulting in allograft dysfunction and the rapid onset of congestive heart failure. Reactivation rates have been well documented in Latin America; however, there is a paucity of data regarding the risk in non‐endemic countries.MethodsWe present our experience with 31 patients with chronic Chagas disease who underwent orthotopic heart transplantation in the United States from 2012 to 2016. Patients were monitored following a standard schedule.ResultsOf the 31 patients, 19 (61%) developed evidence of reactivation. Among the 19 patients, a majority (95%) were identified by laboratory monitoring using polymerase chain reaction testing. One patient was identified after the onset of clinical symptoms of reactivation. All subjects with evidence of reactivation were alive at follow‐up (median: 60 weeks).ConclusionsTransplant programs in the United States are encouraged to implement a monitoring program for heart transplant recipients with Chagas disease. Our experience using a preemptive approach of monitoring for Chagas disease reactivation was effective at identifying reactivation before symptoms developed. Heart transplantation has been shown to be a safe and effective intervention for progressive cardiomyopathy from chronic Chagas disease. However, in the presence of the immunosuppression required for heart transplantation, the likelihood of Chagas disease reactivation is significant. Reactivation may cause myocarditis resulting in allograft dysfunction and the rapid onset of congestive heart failure. Reactivation rates have been well documented in Latin America; however, there is a paucity of data regarding the risk in non-endemic countries. We present our experience with 31 patients with chronic Chagas disease who underwent orthotopic heart transplantation in the United States from 2012 to 2016. Patients were monitored following a standard schedule. Of the 31 patients, 19 (61%) developed evidence of reactivation. Among the 19 patients, a majority (95%) were identified by laboratory monitoring using polymerase chain reaction testing. One patient was identified after the onset of clinical symptoms of reactivation. All subjects with evidence of reactivation were alive at follow-up (median: 60 weeks). Transplant programs in the United States are encouraged to implement a monitoring program for heart transplant recipients with Chagas disease. Our experience using a preemptive approach of monitoring for Chagas disease reactivation was effective at identifying reactivation before symptoms developed. |
| Author | Vikram, Holenarasipur R. Rivera, Hilda La Hoz, Ricardo M. Benedict, Theresa Gray, Elizabeth B. Green, Jaime S. Montgomery, Susan P. |
| AuthorAffiliation | 4 Division of Infectious Diseases, Mayo Clinic, Phoenix, Arizona 2 Division of Infectious Diseases and Geographic Medicine, University of Texas Southwestern Medical Center, Dallas, Texas 1 Parasitic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia 3 Division of Infectious Disease and International Medicine, University of Minnesota Medical Center, Minneapolis, Minnesota |
| AuthorAffiliation_xml | – name: 1 Parasitic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia – name: 3 Division of Infectious Disease and International Medicine, University of Minnesota Medical Center, Minneapolis, Minnesota – name: 2 Division of Infectious Diseases and Geographic Medicine, University of Texas Southwestern Medical Center, Dallas, Texas – name: 4 Division of Infectious Diseases, Mayo Clinic, Phoenix, Arizona |
| Author_xml | – sequence: 1 givenname: Elizabeth B. orcidid: 0000-0003-3111-3537 surname: Gray fullname: Gray, Elizabeth B. email: ebgray@cdc.gov organization: Parasitic Diseases Branch, Centers for Disease Control and Prevention – sequence: 2 givenname: Ricardo M. surname: La Hoz fullname: La Hoz, Ricardo M. organization: University of Texas Southwestern Medical Center – sequence: 3 givenname: Jaime S. surname: Green fullname: Green, Jaime S. organization: University of Minnesota Medical Center – sequence: 4 givenname: Holenarasipur R. surname: Vikram fullname: Vikram, Holenarasipur R. organization: Mayo Clinic – sequence: 5 givenname: Theresa surname: Benedict fullname: Benedict, Theresa organization: Parasitic Diseases Branch, Centers for Disease Control and Prevention – sequence: 6 givenname: Hilda surname: Rivera fullname: Rivera, Hilda organization: Parasitic Diseases Branch, Centers for Disease Control and Prevention – sequence: 7 givenname: Susan P. surname: Montgomery fullname: Montgomery, Susan P. organization: Parasitic Diseases Branch, Centers for Disease Control and Prevention |
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| Keywords | Chagas disease heart transplant reactivation Trypanosoma cruzi |
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| Notes | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 14 content type line 23 AUTHORS’ CONTRIBUTIONS EBG and SPM participated in the conception and design of the project; RML, JSG, and VRH contributed patient summaries for the case series; TB and HR performed serologic and PCR laboratory testing; EBG analyzed data; EBG wrote the manuscript; and RML, JSG, VRH, TB, HR, and SPM critically revised the manuscript. |
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Heart transplantation has been shown to be a safe and effective intervention for progressive cardiomyopathy from chronic Chagas disease. However, in... Heart transplantation has been shown to be a safe and effective intervention for progressive cardiomyopathy from chronic Chagas disease. However, in the... BackgroundHeart transplantation has been shown to be a safe and effective intervention for progressive cardiomyopathy from chronic Chagas disease. However, in... |
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| SubjectTerms | Activation Adult Aged Allografts - parasitology Allografts - pathology Cardiomyopathy Chagas Cardiomyopathy - epidemiology Chagas Cardiomyopathy - parasitology Chagas Cardiomyopathy - pathology Chagas Cardiomyopathy - surgery Chagas disease Congestive heart failure Coronary artery disease Female Follow-Up Studies Heart Heart - parasitology Heart Failure - epidemiology Heart Failure - parasitology Heart Failure - pathology Heart Failure - surgery heart transplant Heart transplantation Heart Transplantation - adverse effects Humans Immunosuppression Immunosuppression Therapy - adverse effects Immunosuppression Therapy - methods Male Middle Aged Monitoring Myocarditis Myocardium - pathology Patients Polymerase chain reaction Preempting reactivation Recurrence Risk Factors Transplantation Transplants & implants Trypanosoma cruzi Trypanosoma cruzi - isolation & purification United States - epidemiology Vector-borne diseases |
| Title | Reactivation of Chagas disease among heart transplant recipients in the United States, 2012‐2016 |
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