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Published on: June 23, 2014
Survival after heart transplantation for Chagas cardiomyopathy using a conventional protocol: A 10-year experience in
Luis E Echeverría1,2, Antonio Figueredo2,3, María J Rodriguez1
1Heart Failure and Heart Transplant Clinic, Fundación Cardiovascular de Colombia, Floridablanca, Colombia.
Insights
Heart transplant (HT) is a safe and effective treatment for Chagas cardiomyopathy (CCM), even without specific anti-parasitic therapy or close monitoring. This study found low reactivation rates and favorable survival outcomes in CCM patients undergoing HT.
Area of Science:
- Cardiology
- Infectious Diseases
- Transplantation Medicine
Background:
- Heart transplant (HT) is crucial for end-stage heart failure in Chagas cardiomyopathy (CCM).
- Limited access to benznidazole therapy and RT-PCR monitoring poses challenges for HT in CCM patients due to reactivation concerns.
- This study evaluated HT outcomes in CCM patients using a standard protocol without benznidazole or RT-PCR.
Purpose of the Study:
- To assess the safety and efficacy of heart transplantation in Chagas cardiomyopathy patients.
- To evaluate outcomes, including survival, rejection, infectious complications, and reactivation rates.
- To determine if a conventional HT protocol is viable for CCM without specific anti-parasitic measures.
Main Methods:
- Retrospective cohort study of 43 Chagas cardiomyopathy patients undergoing heart transplantation between 2008 and 2018.
- Analysis included descriptive statistics for outcomes and survival analysis.
- Patients were treated with a conventional immunosuppression protocol (mycophenolate mofetil) without benznidazole prophylaxis or RT-PCR.
Main Results:
- Overall survival at 1, 5 years was 85% and 75%, respectively, with infections as the primary cause of death (60%).
- A low rate of Trypanosoma cruzi reactivation (7.34%) was observed, with no impact on mortality.
- The study demonstrated favorable survival and low reactivation rates in CCM patients post-HT.
Conclusions:
- Heart transplantation in Chagas cardiomyopathy patients using conventional protocols is safe and associated with favorable survival.
- The absence of benznidazole prophylaxis and RT-PCR monitoring did not significantly increase reactivation-related mortality.
- Performing HT in CCM patients following standard guidelines for other etiologies is a viable and effective strategy.
Background:
Heart transplant (HT) remains the most frequently indicated therapy for patients with end-stage heart failure that improves prognosis in Chagas cardiomyopathy (CCM). However, the lack of benznidazole therapy and availability of RT-PCR follow-up in many centers is a major limitation to perform this life-saving intervention, as there are concerns related with the risk of reactivation. We aimed to describe the outcomes of a cohort of patients with CCM who underwent HT using a conventional protocol with mycophenolate mofetil, without benznidazole prophylaxis or RT-PCR follow-up.
Methods:
Retrospective cohort study. Between 2008 and 2018, 43 patients with CCM underwent HT. A descriptive analysis to characterize outcomes as rejection, infectious and neoplastic complications and a survival analysis was carried out.
Results:
Median of follow-up was 4.3 (IR 4.28) years. Survival at 1 month, 1 year, and 5 years was 95%, 85%, and 75%, respectively, infections being the main cause of death (60%). Reactivations occurred in only three patients (7.34%) and were not related to mortality.
Conclusion:
This cohort showed a favorable survival and a low reactivation rate without an impact on mortality. Our results suggest that performing HT in patients with CCM following conventional guidelines and recommendations for other etiologies is a safe approach.
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