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Transplantation for Chagas Heart Disease: a Comprehensive Review

  • Thoracic Transplantation (J Patel and AM Holm, Section Editors)
  • Published:
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Abstract

Purpose of Review

Chagas cardiomyopathy (CC) has a worse prognosis than other forms of cardiomyopathy and up to 10% of patients may progress to end-stage heart failure. In this article, we have performed a comprehensive literature review of heart transplantation (HT) for CC, including results after HT, management of immunosuppression, and Chagas disease (CD) reactivation.

Recent Findings

CD used to be considered a contraindication to HT due to the risks of disease reactivation with immunosuppression. Nonetheless, multiple reports have consistently demonstrated the feasibility and safety of HT for refractory CC. CD reactivation must be routinely screened in the first-year post-transplant, and in recent years, polymerase chain reactions (PCR)-based techniques have been used more often.

Summary

HT is now considered the best treatment for end-stage Chagas heart disease. In addition, studies of immunosuppressive medications have shown that these patients require a lesser degree of immunosuppression, mainly to balance reactivation risks.

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Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Acknowledgements

The authors are very grateful to Dr. Luiz Benvenuti and to Dr. Amanda Maneschy for providing pathology and CMR media, respectively.

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Authors and Affiliations

  1. Faculdade de Medicina, Instituto Do Coração (InCor), Hospital das Clínicas, Universidade de São Paulo, São Paulo, Brazil

    Fernando Bacal, Ciro Mancilha Murad, Carlos Aurélio dos Santos Aragão, Iáscara Wozniak de Campos, Luis Fernando Bernal da Costa Seguro, Mônica Samuel Avila, Sandrigo Mangini, Fabio Antonio Gaiotto, Tania Varejão Strabelli & Fabiana G. Marcondes-Braga

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  1. Fernando Bacal
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Correspondence to Fernando Bacal.

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Bacal, F., Murad, C.M., dos Santos Aragão, C.A. et al. Transplantation for Chagas Heart Disease: a Comprehensive Review. Curr Transpl Rep 8, 344–350 (2021). https://doi.org/10.1007/s40472-021-00348-9

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