A Systematic Review of Studies on Heart Transplantation for Patients With End-Stage Chagas’ Heart Disease

Abstract Background Uncertainties regarding indications for the procedure, proper immunosuppressive regimen, and the fear of Trypanosoma cruzi infection reactivation are major concerns regarding heart transplantation (HTx) for patients with end-stage Chagas’ heart disease. Methods and Results To rev...

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Bibliographic Details
Published in:Journal of cardiac failure 2009-04, Vol.15 (3), p.249-255
Main Authors: Bestetti, Reinaldo B., MD, PhD, FESC, Theodoropoulos, Tatiana A.D., MD, PhD
Format: Article
Language:English
Subjects:
Allopurinol - therapeutic use
American trypanosomiasis, heart transplantation, heart failure
Cardiovascular
Chagas Disease - drug therapy
Chagas Disease - mortality
Chagas Disease - surgery
Chagas’ disease
Graft Rejection
Heart Transplantation - mortality
Humans
Immunosuppressive Agents - therapeutic use
Neoplasms - epidemiology
Nitroimidazoles - therapeutic use
Perioperative Care
Postoperative Complications
Recurrence
Trypanocidal Agents - therapeutic use
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Summary:Abstract Background Uncertainties regarding indications for the procedure, proper immunosuppressive regimen, and the fear of Trypanosoma cruzi infection reactivation are major concerns regarding heart transplantation (HTx) for patients with end-stage Chagas’ heart disease. Methods and Results To review indications for HTx, current immunosuppressive therapy, posttransplant morbidities, and outcome in Chagas’ heart transplant recipients. Review of articles linking HTx and Chagas’ disease at PubMed and Scielo database from 1966 onward. HTx can reasonably be indicated in patients with an annual probability of death of 70%. HTx has been associated with a similar incidence of rejection episodes in Chagas’ and non-Chagas’ heart transplant recipients. A lower incidence of infection episodes has been observed in Chagas’ in comparison to non-Chagas’ heart transplant recipients. T. cruzi infection reactivation is easily treated with either benznidazole or allopurinol and portends a very low mortality rate. Other posttransplant morbidities have a similar incidence in Chagas’ and in non-Chagas’ patients. Survival probability for Chagas’ HTx recipients at 1 month, 1 year, 4 years, and 10 years follow-up is 83%, 71%, 57%, and 46%, respectively. Such an outcome is better than that seen in non-Chagas’ heart transplant recipients. Conclusions HTx is safe and efficacious for patients with end-stage Chagas’ heart disease.
ISSN:1071-9164
1532-8414
DOI:10.1016/j.cardfail.2008.10.023