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Heart transplantation in patients with Chagas' disease cardiomyopathy
N A Stolf1, L Higushi, E Bocchi
1Department of Cardiovascular Surgery, Instituto Do Coracao, University of São Paulo Medical School, Brazil.
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Heart transplantation in Chagas
Area of Science:
- Cardiology
- Infectious Diseases
- Transplantation Immunology
Background:
- Chagas' disease cardiomyopathy affects heart transplant recipients.
- Immunosuppression management is critical in these patients.
Purpose of the Study:
- To analyze the outcomes of heart transplantation in patients with Chagas' disease cardiomyopathy.
- To identify potential complications and management strategies.
Main Methods:
- Retrospective analysis of 26 heart transplant patients.
- Four patients had pre-existing Chagas' disease cardiomyopathy.
- Clinical data, immunosuppressive protocols, and post-transplant events were reviewed.
Main Results:
- Three of four patients developed a new acute phase of Chagas' disease post-transplantation.
- Steroid pulse therapy was associated with Chagas' reactivation.
- Specific therapy rapidly reversed Chagas' disease manifestations.
- One patient died due to rejection; others had good outcomes.
Conclusions:
- Steroid pulse therapy may trigger Chagas' disease reactivation.
- Acute Chagas' disease presentation can be atypical post-transplant.
- Heart transplantation is feasible in Chagas' cardiomyopathy with careful management.
Abstract:
Among 26 heart transplant patients, four had Chagas' disease cardiomyopathy. They were male patients, aged 28 to 43 years; three were in New York Heart Association class IV, and one was in class II but with refractory arrhythmias. The immunosuppressive protocol was cyclosporine and steroids in the first patient, and cyclosporine, azathioprine, and steroids in the last patient. Three patients had one or more rejection episodes, and one had none. One patient had a lymphoproliferative intestinal disease. Three patients had a new acute phase of Chagas' disease in postoperative days 59, 81, and 420, with fever, skin lesions, and myocarditis. The Trypanosoma cruzi was found in skin lesions in all three patients and in the myocardial biopsy in two patients. The laboratory tests did not show the expected results for the acute phase. All the alterations were reversed by specific therapy in a few days. One patient died on postoperative day 197 from rejection, and the immunosuppression was diminished because of the lymphoproliferative disease; the others were well 107, 160, and 500 days after the transplantation. The conclusions were as follows: (1) It seems that steroid pulse therapy predisposes the patient to a new acute phase of Chagas' disease. (2) Clinical presentation and laboratory test results of the acute phase are not the usual. (3) Specific drug therapy reverses all the alterations of this acute phase in a few days. (4) Although additional care is necessary and specific complications are expected, heart transplantation can be done with good results in patients with Chagas' cardiomyopathy.