Transplantation for chagas' disease: closing the knowledge gap

Area of Science:

• Infectious Diseases
• Transplant Surgery
• Parasitology

Background:

• Chagas disease, caused by Trypanosoma cruzi, primarily affects immigrants in non-endemic regions.
• Solid organ transplantation is a treatment option for advanced Chagas cardiomyopathy.
• Chronic T. cruzi infection poses risks of reactivation and transmission in transplant settings.

Purpose of the Study:

• Review recent literature on Chagas disease epidemiology and treatment.
• Assess risks of Chagas disease reactivation and donor-derived infection in solid organ transplant recipients.
• Evaluate current prevention and management strategies.

Main Methods:

• Literature review of recent studies on Chagas disease.
• Analysis of epidemiological data and treatment outcomes.
• Examination of screening, monitoring, and preemptive treatment protocols.

Main Results:

• Benznidazole and nifurtimox are standard treatments; newer antifungals offer no added benefit.
• Reduced benznidazole dosing may be feasible, but unlikely to prevent established cardiomyopathy.
• Transplant candidates and donors with T. cruzi infection require careful screening and monitoring.
• Post-transplant outcomes are comparable for Chagas patients and other transplant recipients.

Conclusions:

• Solid organ transplantation is safe for patients with chronic T. cruzi infection.
• Screening transplant candidates and donors for T. cruzi infection is essential.
• Monitoring recipients and preemptive treatment can prevent Chagas disease reactivation and transmission.