Elsevier

Transplantation Proceedings

Volume 37, Issue 6, July–August 2005, Pages 2793-2798
Transplantation Proceedings

Other transplant
Later Evolution After Cardiac Transplantation in Chagas’ Disease

https://doi.org/10.1016/j.transproceed.2005.05.038Get rights and content

Abstract

Objective

This research reported the accumulated experience with cardiac transplantation in Chagas’ disease, emphasizing reactivation, immunosuppression, and mortality.

Methods

Fifty-nine patients undergoing cardiac transplantation had Chagas’ disease with classically accepted recipient selection criteria. In this series, 84.7% of the patients were functional class IV; 36.0% used vasopressor support; and 13.5% mechanical circulatory assistance. One patient received a heart and kidney transplantation.

Results

After the initial experience the doses of immunosuppressiants were significantly reduced with improvement in outcomes. The diagnosis of the reactivation of disease was documented by the identification of parasite in the myocardium, or on subcutaneous or serological exams. Reactivation of disease was significantly reduced by decreasing the immunosuppression. Immediate mortality occurred in 10 cases: three infections, two allograft dysfunction, two rejections, and two sudden deaths. Subsequent mortality happened in 14 patients: four by lymphoma, three by infection, two by Kaposi’s sarcoma two by rejection, two by constrictive pericarditis, and one by reactivation of disease in the brain.

Conclusions

There’s no correlation between the disease and pre- or postoperative prophylaxis. The early diagnosis and specific treatment of reactivation did not leave functional sequelae in the myocardium. Reduction in immunosuppression significantly reduced reactivation of disease and neoplasms. The combined transplantation can be realized safely with more care about the immunosuppressants.

Section snippets

Methods

From March 1985 to April 2004 (19 years), 285 patients with cardiomyopathy in an advanced phase underwent cardiac transplantation with 59 (20.7%) of them having Chagas’ disease. After dilated and ischemic cardiomyopathy this disease represented the third cause of heart failure among transplantation indications.

The patients were between 11 and 63 years old (44.4 ± 55.2 months), including 41 (63.5%) men. The overall observation period was between 4 days and 204 months (44.4 ± 55.2 months). Fifty

Results

After the transplantations, the native hearts were subjected to pathological examination that showed chronic myocarditis in 57 (96.6%) hearts; narrow-necked left ventricule in 39 (66.1%); intracavity thrombus in 18 (30.5%); and the amastigote stages of T cruzi in 12 (20.3%). In the first phase of experience (10 patients), the immediate doses of cyclosporine were between 5 and 10 mg/kg/d; the average was 6.70 ± 1.77 mg/kg/d. In the second phase (49 patients), the initial cyclosporine doses were

Discussion

Since the original description of Chagas’ disease in 1911, a great number of improvements have been made in the understanding of its physiopathology.9 The drugs used against the acute phase have low efficacy without the capacity to definitely eradicate the protozoa from the patient. Orientation of public health to control the disease is the most effective way. The cardiac manifestations of Chagas’ disease are the most serious. They are progressive to death in the final phase of the disease. The

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