CARDIAC ALLOGRAFT VASCULOPATHY AND SURVIVAL AFTER HEART TRANSPLANTATION FOR CHAGAS HEART DISEASE

DIEZ M; FAVALORO LE; BERTOLOTTI A; VIGLIANO C; PERADEJORDI LASTRA M; SCHIJMAN A; FAVALORO RR

Praga

Congreso; 32nd Annual Meeting and Scientific Sessions; 2012

International Society for Heart and Lung Transplantation

Purpose: To evaluate the incidence of reactivation (Ra) and cardiac allograft vasculopathy (CAV) in patients (pts) with heart transplant (HTx) due to Chagas cardiomyopathy (ChC) and compare the outcome of this patients to others aetiologies. Methods and Materials: 23 out of 284 pts who underwent HTx had ChC (Group 1). The aetiology in the 261 remainder pts (Group 2) was idiopathic cardiomyopathy in 66 pts (25.3%), ischemic 79 pts (30.3 %), and others 116 pts (44.4%). Mean follow-up was 5.6 ± 2.69 yr in G1 and 5.6 ± 5.08 yr in G 2. Parasitemia was determined using the Strout method. To detect T.cruzi DNA, two PCR strategies with different degree of sensitivity were carried out. The pts were started on immunosuppression with triple drug: calcineurin inhibitors, azathioprine or mycophenolate mofetil (MMF) and steroids; they were not given prophylactic benznidazole (BNZ). Definition of CAV was based on the ISHLT Consensus Statement 2010. Results: The in-hospital mortality rate was 13% in G1 vs 15% in G2 (p: 0.8). Eight ChC pts exhibited Ra (34.7%): 6 had skin lesions, 1 had parasitemia and 1 had Chagasic myocarditis; 1 pt had Ch myocarditis relapsed. The mean Ra time was 75 days (d) (range 38-120); 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. k-DNA and SL-DNA PCR were positive 50 d and 36 d before Ra. The use of MMF was no related to Ra episodes: 2/8 pts in Ra group vs 6/15 pts in non Ra group. (p:0.47). All the Ra were successfully treated with BNZ. The incidence of CAV was 12.4% in GI and 12.5% in G2. Survival at 1, 3 and 5 years was 82%, 82% and 68% for G1 and 80%, 75% and 71% in G2 (log rank test p0.7). Conclusions: Ra was observed in 34.7% in chagasic recipients, treatment with BNZ was successful and any pts died because of Ra. The incidence of CAV and the survival results after HTx are similar between chagasic and no chagasic recipients. This confirms that HTx is a valuable treatment option in ChC.