title: Later evolution after cardiac transplantation in Chagas' disease.
abstract: OBJECTIVE
  This research reported the accumulated experience with cardiac transplantation in Chagas' disease, emphasizing reactivation, immunosuppression, and mortality.
  
  
  METHODS
  Fifty-nine patients undergoing cardiac transplantation had Chagas' disease with classically accepted recipient selection criteria. In this series, 84.7% of the patients were functional class IV; 36.0% used vasopressor support; and 13.5% mechanical circulatory assistance. One patient received a heart and kidney transplantation.
  
  
  RESULTS
  After the initial experience the doses of immunosuppressants were significantly reduced with improvement in outcomes. The diagnosis of the reactivation of disease was documented by the identification of parasite in the myocardium, or on subcutaneous or serological exams. Reactivation of disease was significantly reduced by decreasing the immunosuppression. Immediate mortality occurred in 10 cases: three infections, two allograft dysfunction, two rejections, and two sudden deaths. Subsequent mortality happened in 14 patients: four by lymphoma, three by infection, two by Kaposi's sarcoma two by rejection, two by constrictive pericarditis, and one by reactivation of disease in the brain.
  
  
  CONCLUSIONS
  There's no correlation between the disease and pre- or postoperative prophylaxis. The early diagnosis and specific treatment of reactivation did not leave functional sequelae in the myocardium. Reduction in immunosuppression significantly reduced reactivation of disease and neoplasms. The combined transplantation can be realized safely with more care about the immunosuppressants.
authors.affiliation: Heart Institute of Medicine, School of Sao Paulo University, Sao Paulo, Brazil. fiorelliai@uol.com.br
authors.forename: A I
authors.initials: AI
authors.lastname: Fiorelli
authors.forename: N A G
authors.initials: NA
authors.lastname: Stolf
authors.forename: R
authors.initials: R
authors.lastname: Honorato
authors.forename: E
authors.initials: E
authors.lastname: Bocchi
authors.forename: F
authors.initials: F
authors.lastname: Bacal
authors.forename: D
authors.initials: D
authors.lastname: Uip
authors.forename: T
authors.initials: T
authors.lastname: Strabelli
authors.forename: V
authors.initials: V
authors.lastname: Issa
authors.forename: V A
authors.initials: VA
authors.lastname: Amato
authors.forename: L R
authors.initials: LR
authors.lastname: Fiorelli
authors.forename: S A
authors.initials: SA
authors.lastname: Oliveira
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D009202:Cardiomyopathies / Q000469:parasitology / Q000601:surgery*; D002423:Cause of Death; D014355:Chagas Disease / Q000150:complications*; D016572:Cyclosporine / Q000627:therapeutic use; D016027:Heart Transplantation / Q000276:immunology / Q000401:mortality / Q000502:physiology*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D012189:Retrospective Studies; D016019:Survival Analysis
chemical_list: D000305:Adrenal Cortex Hormones; D007166:Immunosuppressive Agents; D016572:Cyclosporine