Transplantation for Chagas' disease: an overview of immunosuppression and reactivation in the last two decades.
Over the last 20 yr, the immunosuppression protocols in chagasic heart-transplanted patients have gone through three phases, and we have identified several changes and discoveries about Chagas' disease reactivation, mortality, and neoplasia development. The first phase was especially important because until that time, Chagas' disease was an absolute contraindication for transplantation. The second phase started when an adjustment was made to the immunosuppression protocol, a lower dosage being adopted to avoid adverse effects, especially neoplasias and reactivation episodes. Currently, strategies to change the immunosuppression, especially replacement of mycophenolate mofetil by azathioprine or low doses of mycophenolate in this special situation, have been shown to be effective in reducing Chagas' disease reactivation. Cardiac transplantation for Chagas' disease is a reality. Although patients with Chagas' disease may experience particular complications when undergoing transplantation compared with transplantation for other etiologies, these difficulties are well known, and treatment and preventive strategies are also better established. In other organs and tissues, transplantation in patients with Chagas' disease also has good outcomes. Blood monitoring for parasitemias is mandatory as is the institution of therapy in the case of a reactivation diagnosis. Acute Chagas' disease may occur in patients who received organs from donors with Chagas' disease.
Bacal
Fernando
F
Heart Institute (InCor), University of São Paulo, Medical School - Heart Transplant Unit, São Paulo, Brazil. fbacal@uol.com.br
Silva
Christiano Pereira
CP
Pires
Philippe Vieira
PV
Mangini
Sandrigo
S
Fiorelli
Alfredo Inacio
AI
Stolf
Noedir Groppo
NG
Bocchi
Edimar Alcides
EA
D002598:Chagas Cardiomyopathy / Q000401:mortality / Q000601:surgery*; D014355:Chagas Disease / Q000175:diagnosis / Q000276:immunology; D000075202:Contraindications; D016027:Heart Transplantation; D006801:Humans; D007165:Immunosuppression Therapy / Q000379:methods* / Q000639:trends; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016377:Organ Transplantation; D012008:Recurrence
D007166:Immunosuppressive Agents