Usefulness of Polymerase chain reaction for early diagnosis of Chagas disease reactivation in Heart Transplantation.

35 DIEZ M;, FAVALORO L; BERTOLOTTI A, BURGOS J, VIGLIANO C; PERADEJORDI LASTRA M; LEVIN MJ;ARNEDO A; NAGEL C; SCHIJMAN A.G.; FAVALORO RR

American Journal of Transplantation

Blackwell, 2007

Año: 2006 vol. 7 p. 1633 - 1640

Heart transplantation (HTx) is a useful therapy for end-stage Chaga´s cardiomyopathy; however, Chagas reactivation remains a mayor complication. Parasitological methods offer poor diagnostic sensitivity, and use of more sensitive tools such as the Polymerase chain reaction (PCR) is usually necessary. In the present study, reactivation incidence and PCR usefulness for early reactivation diagnosis, as well as for treatment response evaluation during follow-up, were analyzed using Strous parasite detection test, in 10 of 222 consecutive HTx patients suffering Chaga´s cardiomyopathy. PCR strategies targeted to minicircle sequences (kDNA, detection limit 1 parasite/ 10 mL blood) and miniexon genes (SL-DNA, 200 parasite/10 mL) were performed to compare parasite burdens between samples. No patients received prophylactic antiprotozoal therapy (benznidazole). Five patients (50%) exhibited clinical reactivation within a mean period of 71.6 days; positive Strout results were observed in most cases presenting clinical manifestations. kDNAPCR was positive 38–85 days before reactivation, whereas SLDNA-PCR became positive only 7–21 days later, revealing post-HTx parasitic load enhancement present prior to clinical reactivation development. Reactivations were successfully treated with benznidazole and generated negative PCR results. Results observed in this study indicate the value of PCR testing for an early diagnosis of Chagas reactivation as well as for monitoring treatment efficacy.