Abstract 11656: Chagas Disease Reactivation After Heart Transplant in an Endemic Country
| Autor: | Lukas Salazar, Ramon Medina, Juan Felipe F Vasquez, John Ramirez, Mónica López, Maria J Rodriguez |
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| Rok vydání: | 2021 |
| Předmět: | |
| Zdroj: | Circulation. 144 |
| ISSN: | 1524-4539 0009-7322 |
| Popis: | Introduction: Chagas disease (CD) is a common cause of advanced heart failure in Colombia and the third cause of heart transplant in our center. For transplanted patients the immunomodulatory therapy is crucial, but it makes them susceptible to CD reactivation. Fiorelli et al showed a frequency of reactivation of 40% based in histological diagnosis; also, Gray et al reported a frequency of 61% using quantitative PCR. The estimation of this phenomenon in our population is essential to improve its management. Methods: We performed a retrospective cohort study of patients with heart transplant due to chagasic cardiomyopathy. The primary outcome was the prevalence of CD reactivation. Secondary outcomes included the description of clinical manifestations, immunomodulatory therapies used and the time elapsed since the transplant until the reactivation. Reactivation was defined as a positive RT-PCR for T.cruzi after heart transplant or a compatible endomyocardial biopsy. The RT-PCR test was performed if clinical deterioration, ventricular disfunction, or either randomly according to physician criteria. Results: Fifteen patients were included in the analysis. The age at the moment of the transplant was 54 YO (IQR 43-56), 67% were men. CD reactivation was diagnosed in the 67% of patients (Figure 1a). The median of the time to CD reactivation after the transplant is 12 months (95%-CI:3,16-20,8) (Figure 1b). The mortality during follow-up was 0% and the longest follow-up time was 11 years.The most frequently used drugs in patients with reactivation were cyclosporine, tacrolimus and corticosteroids. All of the patients with reactivation received benznidazole. Conclusions: There is a high prevalence of CD reactivation in heart transplanted patients due to Chagasic cardiomyopathy, especially during the first year. Protocols for screening these condition are necessary for an adequate care of these patients. Cualitative RT-PCR test and myocardial biopsy should be considered. |
| Databáze: | OpenAIRE |
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