Heart transplantation for chronic Chagas' heart disease.
BACKGROUND
Chagas' disease has been considered a contraindication to heart transplantation as Trypanosoma cruzi infection could recur after immunosuppression.


METHODS
We report the follow-up of 22 patients who underwent orthotopic heart transplantation for treatment of end-stage chronic Chagas' heart disease, divided in two groups. Group 1 consisted of 9 patients operated on from September 1985 to June 1991, and group 2 patients underwent transplantation from July 1991 to June 1995. After our early experience with group 1, we attempted to use a lower cyclosporine dosage in group 2.


RESULTS
Total actuarial survival at 24 months was 60%, and it was better for group 2 (33% for group 1, 80% for group 2, p = 0.008). Parasitemia occurred similarly in both groups, but Chagas' disease reactivation was seen in 5 group 1 patients and in 1 group 2 member (p < 0.002). Neoplasia developed in 5 group 1 patients and 1 group 2 patient, and contributed to death in 3 of them.


CONCLUSIONS
These data demonstrate satisfactory outcome of cardiac transplantation in patients with end-stage Chagas' heart disease in the second phase of our experience. Further progress is necessary to improve the results and evaluate its proper role in the management of this disease.
Bocchi
E A
EA
Heart Institute, São Paulo University Medical School, Brazil.
Bellotti
G
G
Mocelin
A O
AO
Uip
D
D
Bacal
F
F
Higuchi
M L
ML
Amato-Neto
V
V
Fiorelli
A
A
Stolf
N A
NA
Jatene
A D
AD
Pileggi
F
F
D000206:Actuarial Analysis; D000293:Adolescent; D000328:Adult; D001379:Azathioprine / Q000008:administration & dosage / Q000627:therapeutic use; D002423:Cause of Death; D002598:Chagas Cardiomyopathy / Q000601:surgery*; D002648:Child; D016572:Cyclosporine / Q000008:administration & dosage / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000008:administration & dosage / Q000627:therapeutic use; D006084:Graft Rejection / Q000188:drug therapy; D016027:Heart Transplantation; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000627:therapeutic use; D008223:Lymphoma / Q000209:etiology; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage / Q000627:therapeutic use; D008875:Middle Aged; D009205:Myocarditis / Q000469:parasitology / Q000601:surgery; D018512:Parasitemia / Q000175:diagnosis; D011241:Prednisone / Q000008:administration & dosage / Q000627:therapeutic use; D012008:Recurrence; D012514:Sarcoma, Kaposi / Q000209:etiology; D015996:Survival Rate; D016896:Treatment Outcome
D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D016572:Cyclosporine; D001379:Azathioprine; D011241:Prednisone; D008775:Methylprednisolone