Trypanozoma cruzi Infection in Patients Undergoing Solid Organ Transplantation

Abstract

Background. It is estimated that 1.5 million people are infected with T. cruzi in Argentina (4%). Chagas reactivation rate (R) in patients with solid organ transplantation (SOT) is around 33%, being higher in cardiac transplantation (Tx). Objective(s): To describe the clinical characteristics, evolution, mortality, to evaluate reactivation risk factors and to analyze the usefulness of molecular tests in patients undergoing at SOT with Chagas' disease risk (ChR) (R or Donor-derived transmission,-DT-), in a hospital in our country. Methods. Retrospective cohort from all the patients who received an SOT in our hospital from January 1988 to March 2017. All patients with ChR: either R or DT were analyzed. Inclusion: survival more 30 days and 6 months of follow-up or until death. We performed post-Tx monitoring with parasitaemia (Strout), and serial whole blood polymerase chain reaction (PCR) testing, weekly until 2 months, every 2 weeks until the sixth month and monthly until the year, later annual. PCR monitoring is done since 2006. Results. We performed 1932 SOT in 29 years: 54 SOT in patients with ChR, 46 chagasic recipients (CR) and 8 chagasic donors (CD) to negative recipient 24/46 (52%) presented R, (see Table 1), 4 had more than one episode. Time to first R was 67 days (r = 3-296, median 30 days). At the time of the R Strout was performed in 19 episode 13 were negative, PCR was positive in 10/10 of perfcormed test, 32% vs.100% (P = 0.001). Clinical R: 5 episode in 4 patients (panniculitis 3, 1 with myocarditis, 1 myocarditis). Strout was negative in 2 of these, in the other episode monitoring had not been performed. Immunosuppression (IS): there were no Differences in the IS, (induction and treatment of rejections). Reactivation: 21/24 responded to treatment, 2 spontaneously PCR-negative, 1 died. Mortality: 6/24 (25%) in pt. R and 2/17 (12%) in pt no R (P = ns), not related mortality. DT occurred in 1/3 liver and in 0/5 renal recipients. [Figure Presented] Conclusion. PCR was more sensitive than Strout for detection of R or transmission. There was no clinical R in pt monitored by PCR. Also PCR sensitivity allow safe acceptance of Chagasic organs.