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(Circulation. 1996;94:1815-1817.)
© 1996 American Heart Association, Inc.

Articles

Heart Transplantation in Chagas' Disease

10 Years After the Initial Experience

Valeria B. de Carvalho, MD; Eduardo F.L. Sousa, MD; Jose Henrique A. Vila, MD; Jose Pedro da Silva, MD; Marcio R. Caiado, MD; Sergio R. de R. Araujo, MD; Radi Macruz, MD; E.J. Zerbini

the Universidade de Sao Paulo (V.B.deC., R.M.); INTERCOR (V.B.deC., E.F.L.S., M.R.C., R.M.); Clinica Cardio Cirurgica J.P. da Silva (J.H.A.V., J.P.daS.); and Department of Pathology of Hospital da Real e Benemerita Sociedade Portuguesa de Beneficencia (S.R.deR.A.), Sao Paulo, Brazil.

Background Heart transplantation (HT) as a therapeutic option for end-stage chronic Chagas' heart disease (CCHD) is controversial. Reactivation of Trypanosoma cruzi infection and recurrence of the disease in the allograft are likely to occur. Furthermore, active myocarditis has been reported to predispose patients to an increased incidence and severity of rejection.

Methods and Results We prospectively investigated the long-term follow-up of 10 patients with CCHD who underwent HT. Immunosuppression was based on cyclosporine A and azathioprine. T cruzi reactivation was prevented with benzonidazole. Besides allograft rejection surveillance, T cruzi infection was monitored through blood tests, myocardial biopsies, and serological tests. Over a mean follow-up period of 34±38 months (range, 73 to 124 months), 7 patients are alive and in NYHA functional class I. Life expectancy was 78% for the second year and 65% for 10 years. Rejection was less frequent in chagasic than in age- and sex-matched control patients (mean±SD, 1.60±1.26 versus 5.70±1.89 episodes per patient, respectively; P=.0001); decreased severity of rejection was also observed (P=.006). T cruzi parasitemias detected on three occasions were successfully treated with benzonidazole. There were no signs of recurrence of the disease in the allograft.

Conclusions These results suggest an important role of HT in the treatment of CCHD. There was a low frequency of T cruzi infection reactivation and no signs of recurrence of the disease in the allograft. The surprisingly decreased rejection incidence and severity require further studies for elucidation.

Key Words: Chagas' disease • transplantation • follow-up studies • myocarditis • rejection

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