Heart transplantation in chagas cardiomyopathy

Abstract

Heart transplantation modifies the natural history of end-stage chronic Chagas cardiomyopathy and is currently established as a valuable therapeutic option.Patients with Chagas disease and heart transplantation require close and multidisciplinary follow-up, since reactivation can occur after heart transplantation. The most frequent clinical manifestations of reactivation are fever, panniculitis and myocarditis. In order to prevent reactivation after heart transplantation, It is recommended to reduce the immunosuppression regimen by avoiding induction and the use of mycophenolate mofetil, as well as early reduction or suspension of steroids.Only blood or tissue parasitological methods have diagnostic value for reactivation. Positive PCR results anticipate the Strout test and the clinical manifestations of reactivation. When it occurs, Benznidazole is the safest and most effective treatment.Heart transplantation is a safe and effective treatment in patients with Chagas cardiomyopathy, since it is associated with a survival similar to those transplanted for other causes, and reactivation of the disease is not associated with higher mortality.