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Heart transplantation for Chagas cardiomyopathy in the United States
E P Kransdorf1, L S C Czer, D J Luthringer
1Cedars-Sinai Heart Institute, Los Angeles, CA.
Insights
Chagas cardiomyopathy (CC) is a frequent reason for heart transplantation (HTx) in the US. Reactivation of Trypanosoma cruzi (TC) infection post-HTx is common and can lead to adverse outcomes.
Area of Science:
- Cardiology
- Infectious Diseases
- Transplantation Immunology
Background:
- Chagas cardiomyopathy (CC) is a significant cause of heart failure in endemic regions.
- Heart transplantation (HTx) is an option for end-stage CC.
- Data on CC patients undergoing HTx in the US are limited.
Purpose of the Study:
- To describe the clinical characteristics, laboratory findings, and outcomes of CC patients undergoing HTx in the US.
- To report the incidence and management of Trypanosoma cruzi (TC) reactivation after HTx in CC patients.
- To evaluate a systematic screening and management program for TC infection in HTx candidates.
Main Methods:
- Retrospective review of 11 patients with CC undergoing HTx between June 2006 and January 2012.
- Screening for TC infection using serology in patients with idiopathic dilated cardiomyopathy from endemic countries before HTx.
- Post-HTx monitoring included clinical assessment, echocardiography, endomyocardial biopsy, and serial whole blood PCR for TC.
Main Results:
- Eleven patients with CC underwent HTx.
- One patient received empirical treatment for TC infection.
- Two patients experienced allograft dysfunction due to TC reactivation; three had subclinical reactivation (positive PCR) treated successfully.
Conclusions:
- Chagas disease is a notable cause of dilated cardiomyopathy in HTx recipients from endemic countries in the US.
- Trypanosoma cruzi reactivation is frequent after heart transplantation and associated with adverse outcomes.
- Systematic screening and proactive management are crucial for improving outcomes in CC patients undergoing HTx.
Abstract:
Since an initial case in 2006, we noted multiple patients undergoing heart transplantation (HTx) for Chagas cardiomyopathy (CC) at our transplant program. The clinical characteristics, laboratory results and outcomes of patients with CC undergoing HTx in the United States have not been reported previously. In 2010, we implemented a systematic screening and management program for patients undergoing HTx for CC. Before HTx, all patients with idiopathic dilated cardiomyopathy who were born in a Chagas disease endemic country were screened for Trypanosoma cruzi (TC) infection with serology. After HTx, monitoring for TC reactivation was performed using clinical visits, echocardiography, endomyocardial biopsy and serial whole blood polymerase chain reaction (PCR) testing. Between June 2006 and January 2012, 11 patients underwent HTx for CC. One patient was empirically treated due to the presence of TC amastigotes in explanted cardiac tissue. Two patients experienced allograft dysfunction due to TC reactivation and three patients experienced subclinical reactivation (positive PCR results), which were treated. Chagas disease is a common cause of dilated cardiomyopathy in patients from endemic countries undergoing HTx at a transplant program in the United States. Reactivation is common after transplantation and can cause adverse outcomes.
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