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Chagas Disease Reactivation after Heart Transplant: Importance of New Predictors

Roberto M. Saraiva et al. Andréa R. Costa

Chronic Chagas disease (CD) affects around 3.7 million Brazilians according to the most recent estimative. As around 30-40% of this population present with the cardiac form, it comes as no surprise that CD is the third most frequent etiology among patients undergoing heart transplant in Brazil. As induction and/or maintenance immunosuppressive therapy carry the risk of CD reactivation (CDR), heart transplant safety could be questioned in CD. However, the experience in Brazil established heart transplants as the leading alternative treatment for CD patients with end-stage heart failure. In fact, the post-transplant survival of patients with CD in Brazil is 76%, 71%, and, 46% after 6 months, five, and 10 years, respectively, and better than the survival of heart transplant recipients with either ischemic or idiopathic cardiomyopathies.^,

CDR incidence after heart transplant varies from 19.6% to 90%. CDR can induce symptoms of acute CD (fever, anemia, jaundice), myocarditis, panniculitis, meningoencephalitis, and brain abscess. Myocarditis is the most frequent complication and may present severe symptoms compatible with heart failure, cardiac arrhythmia, and even cardiogenic shock. Fortunately, CDR properly diagnosed and treated results in less than 1% mortality.

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Chagas Disease Reactivation after Heart Transplant: Importance of New Predictors

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