Liver Transplantation Using Chagas‐Infected Donors in Uninfected Recipients: A Single‐Center Experience Without Prophylactic Therapy

• Published in: American journal of transplantation Vol. 12; no. 10; pp. 2832 - 2837
• Main Authors: McCormack, L., Quiñónez, E., Goldaracena, N., Anders, M., Rodríguez, V., Orozco Ganem, F., Mastai, R. C.
• Format: Journal Article
• Language: English
• Published: Malden, USA Blackwell Publishing Inc 01.10.2012; Wiley; Wiley Subscription Services, Inc
• Subjects: Biological and medical sciences; Chagas Disease - microbiology; Disease transmission; Extended donor criteria; Human protozoal diseases; Humans; Infections; Infectious diseases; Liver; Liver Transplantation; Liver, biliary tract, pancreas, portal circulation, spleen; marginal donors; Medical sciences; Mortality; Parasitic diseases; Prevention and actions; prophylaxis; Protozoal diseases; Public health. Hygiene; Public health. Hygiene-occupational medicine; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Tissue Donors; transplantation; Trypanosomiasis; Suboptimal donor; Human; Protozoal disease; Center; Extended donor criteria; Digestive system; Liver; infectious diseases; Chagas disease; Recipient; Parasitosis; Homotransplantation; prophylaxis; Infection; Prevention; Experience; Treatment; Criterion; Surgery; transplantation; marginal donors; Graft; Trypanosomiasis; Liver transplantation
• ISSN: 1600-6135; 1600-6143
• DOI: 10.1111/j.1600-6143.2012.04160.x

Organ shortage is the first cause of death on liver transplant waiting lists. As a consequence, we recently decided to expand liver acceptance to those organs that could potentially transmit infectious diseases to their recipients. On January 2010, we initiated a prospective protocol using livers from Chagas‐infected donors for transplanting uninfected recipients without using prophylactic therapy. During a 13‐month period, 9 of 37 (24%) liver transplants were performed within this protocol. After transplant, each recipient was sequentially and strictly monitored for infection transmission using the Strout method and promptly treated with benznidazole if this occurs. During follow‐up, two patients died without Chagas infection and only two (donor‐derived T. cruzi transmission rate: 2/9; 22%) patients developed donor‐derived Chagas transmission without clinical symptoms. The median follow‐up time of the seven live patients was 15 months (range: 13–20). At present, all are symptoms‐free with excellent allograft function and without evidence of Chagas disease. In conclusion, we consider that Chagas‐infected donors are a promising source of liver grafts that could reduce the growing mortality on liver waiting lists in America. Relevant data from larger prospective studies are required to confirm these preliminary excellent results. Liver grafts from Chagas‐infected donors can be safely used for transplanting uninfected recipients without the need of prophylactic therapy but under strict scheduled parasitological infection screening.