NOVEL PCR METHOD FOR EARLY DETECTION OF CHAGAS REACTIVATION AFTER HEART TRANSPLANTATION IN CHAGAS DISEASE

FAVALORO LE; PERADEJORDI LASTRA MA; ABSI D; SCHIJMAN A; VIGLIANO CA; NAGEL C; RATTO R; LOPEZ ROSETTI M; BERTOLOTTI A; FAVALORO RR

Londres

Congreso; European Society of Cardiology Congress 2015; 2015

European Society of Cardiology

P1767 | BEDSIDENovel PCR method for early detection of Chagasreactivation afterheart transplantation in Chagas diseaseL.E. Favaloro1,M. Peradejordi1, D. Absi1,A. Schijman2, C. Vigliano1,C. Nagel1,R. Ratto1,M. Lopez Rosetti1, A. Bertolotti1,R.R. Favaloro1. 1FavaloroFoundation. University Hospital,Buenos Aires, Argentina; 2INGEBI - CONICET,Buenos Aires, ArgentinaBackground: Hearttransplantation (HTx) for Chagas cardiomyopathy (ChC) is auseful therapy;however, reactivation (Ra) of Chagas disease is a frequent complication.The sensitivityof parasitological methods is low; therefore, methods thatare moresensitive needed for the early detection of Ra episodes.Objective: To evaluate theprevalence of Ra and the usefulness of the PCR forearly diagnosisof chagasic Ra.Material and methods: Since 1992, 435patients (p) underwent HTx at a singleinstitution. Ofthem, 29 p had ChC. Endomyocardial biopsies were scheduledand performed tomonitor acute rejection. At the same time, parasitemiawas determinedusing Strout method, and three different PCR methods were performedto determinatequalitative and quantitative DNA Trypanosoma cruzi. Onemethod amplifiesthe minicircle variable region of the kinetoplastid genome; anothermethod appliedamplification of the intergenic spacer of the spliced leadergenes, and thethird one is based on an analitycal performance of a multiplexReal Time PCRassay using TaqMan probes for quantification of Trypanosomacruzi satelliteDNA in blood samples.Theimmunosuppression was calcineurin inhibitors, azathioprine (AZA) ormycophenolatemofetil (MMF) andsteroids. The p did not received prophylactic benznidazole.Median follow upwas 1793 days (9¨C4079).Results: Two out of 29(7%) ChC HTx recipients died in the perioperative perioddue to sepsis andprimary graft failure and 11 p (40.7%) presented 12 Ra duringfollow-up: 8 phad skin lesions and 3 p had Chagas myocarditis and a p hadstrout+. Themedian time from HTx to clinical Ra was 87 days (38¨C224), while themedian time frompositive PCR test to clinical Ra was 59 days (38¨C85), 28 daysbefore thesymptoms onset. Positive Strout was observed at the same time of clinicalmanifestationsexcept in 1 p. Acute rejection (AR) grade ¡Ý2R was observedin 9/11 p with Ravs. 9/18 p without Ra (rejection rate: 2.2 vs 0.8 respectively).All episodes ofAR were treated with steroids pulse, and the Ra episodes weresuccessfullytreated with benznidazole. Strout/PCR results became negative afterRa treatment.During long-term follow-up, 7 p died due to: 3 p refractory rejection,2 p sepsis, 1 pin a car collision and 1 acute abdomen. There was no mortalitydue to Ra.Conclusions: Ra was observedin 41% of ChC HTx recipients in this series. Radiagnosis by PCR wasdone earlier as compared to Strout results, showing thatthe former technique is more sensitivethan direct microscopic observation.