REACTIVATION OF T. CRUZI INFECTION AFTER HEART TRANSPLANT

FAVALORO LE; DIEZ M; SCHIJMAN A; VIGLIANO CA; PERADEJORDI LASTRA M; BURGOS J; BERTOLOTTI A; FAVALORO RR

MADRID

Congreso; International Society of Heart and Lung Transplantation 26th Annual Meeting and Scientific Sessions.; 2006

International Society of Heart and Lung Transplantation

Chagas cardiomyopathy (ChC) is a cause of end-stage heart failure in Latin American countries. Heart transplantation (HTx) is a useful therapy; however, reactivation (Ra) of Chagas disease is one of the main complications observed. The sensibility of parasitological methods is low, and therefore more sensitive methods are needed for the early detection of Ra. Objective: To evaluate the prevalence of Ra and the usefulness of the DNA amplification method of T cruzi using PCR for the early detection of Ra. Material and Methods: 10 out of 222 patients (pts.) who underwent HTx had ChC. Endomyocardial biopsies were performed in order to monitor acute rejection (ISHLT system). Parasitemia was determined using the Strout method, and DNA amplification of the parasite was performed using PCR. The pts were started on immunosuppression with calcineurin inhibitors, azathioprine (AZA) or mycophenolate mofetil (MMF) and corticosteroids; they were not given prophylactic benznidazole. Mean follow up: 666 days. Results: The in-hospital mortality rate was 10% (1/10 because of sepsis). Five of the 9 remaining pts exhibited Ra (55.5%); 4 had skin lesions and 1 had Chagas myocarditis. The mean Ra time was 71.6 days (d) (range 38?92); 1 pts showed a positive Strout result 15 d before the Ra; positive results were observed in the rest of the pts when the clinical lesion was detected. PCR was positive 59 d before Ra. Of the 4 pts without Ra, only one became positive between the day 8 to 60 post-HTx ; later this patient became negative after the switch of MMF to AZA. All the Ra were successfully treated with benznidazole; the Strout and PCR results became negative; one of them died of refractory rejection. No differences were observed in the number of rejections grade ³ 3 or rejections with hemodynamic compromise in these groups. Conclusions: Ra was observed in 55.5% of HTx cases in our series. PCR results became positive earlier as compared to the Strout results, which shows that this technique is more sensitive for the early diagnosis of Ra of Chagas disease in HTx.