Reactivation of Chagas disease among heart transplant recipients in the United States, 2012-2016

Elizabeth B. Gray, Ricardo M. La Hoz, Jaime S. Green, Holenarasipur R. Vikram, Theresa Benedict, Hilda Rivera, Susan P. Montgomery

Research output: Contribution to journalArticlepeer-review

53 Scopus citations

Abstract

Background: Heart transplantation has been shown to be a safe and effective intervention for progressive cardiomyopathy from chronic Chagas disease. However, in the presence of the immunosuppression required for heart transplantation, the likelihood of Chagas disease reactivation is significant. Reactivation may cause myocarditis resulting in allograft dysfunction and the rapid onset of congestive heart failure. Reactivation rates have been well documented in Latin America; however, there is a paucity of data regarding the risk in non-endemic countries. Methods: We present our experience with 31 patients with chronic Chagas disease who underwent orthotopic heart transplantation in the United States from 2012 to 2016. Patients were monitored following a standard schedule. Results: Of the 31 patients, 19 (61%) developed evidence of reactivation. Among the 19 patients, a majority (95%) were identified by laboratory monitoring using polymerase chain reaction testing. One patient was identified after the onset of clinical symptoms of reactivation. All subjects with evidence of reactivation were alive at follow-up (median: 60 weeks). Conclusions: Transplant programs in the United States are encouraged to implement a monitoring program for heart transplant recipients with Chagas disease. Our experience using a preemptive approach of monitoring for Chagas disease reactivation was effective at identifying reactivation before symptoms developed.

Original languageEnglish (US)
Article numbere12996
JournalTransplant Infectious Disease
Volume20
Issue number6
DOIs
StatePublished - Dec 2018

Bibliographical note

Funding Information:
We thank the following persons for their contributions to this article: Yvonne Qvarnstrom PhD (Centers for Disease Control and Prevention), TaLesa Aderohunmu (Centers for Disease Control and Prevention), Samaly dos Santos Souza (Centers for Disease Control and Prevention), Darlyne Smith (Centers for Disease Control and Prevention), Marcus Pereira MD (Columbia University Medical Center), Benjamin Miko MD (Columbia University Medical Center), Monica D. Mehta PharmD (New York-Presbyterian Hospital, Columbia University Medical Center), Shalika Katugaha MD (Inova Fairfax Hospital), Mary Schmidt MD (Inova Fairfax Hospital), Rachel Marcus MD (MedStar Washington Hospital Center), Glenn Wortmann MD (MedStar Washington Hospital Center), Cameron R. Wolfe MD (Duke University), Paola Lichtenberger MD (University of Miami), Jacques Simkins MD (University of Miami), Jose F. Camargo MD (University of Miami), David A. Baran MD (Eastern Virginia Medical School), Jennifer Ebuenga-Smith RN (Newark Beth Israel Medical Center), Herbert Tanowitz MD (Albert Einstein College of Medicine), Christina M. Coyle MD (Albert Einstein College of Medicine), Sarah B. Doernberg MD (University of California, San Francisco), Peter V. Chin-Hong MD (University of California, San Francisco), the UCSF Heart Transplant program, the UCSF Transplant ID service, Eddie Stenehjem MD (Intermountain Medical Center), the Intermountain Medical Center Heart Institute, Robin Avery MD (Johns Hopkins Medicine), Deb Carter CRNP (Johns Hopkins Medicine), Laura Hartman CRNP (Johns Hopkins Medicine), Kate Shagena CRNP (Johns Hopkins Medicine), Jennifer K Chow MD (Tufts Medial Center), Helen Boucher, MD (Tufts Medical Center), and David Denofrio MD (Tufts Medical Center).

Publisher Copyright:
Published 2018. This article is a U.S. Government work and is in the public domain in the USA.

Keywords

  • Chagas disease
  • Trypanosoma cruzi
  • heart transplant
  • reactivation

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