Chagas disease and liver transplantation: Experience in Argentina using real‐time quantitative PCR for early detection and treatment

Abstract

A small proportion of T. cruzi-seropositive candidates presented positive parasitemia before LT. After LT, qPCR allowed detection of parasitemia leading to use of preemptive therapy in all R+/D- with T. cruzi replication. No cases of T. cruzi parasitemia occurred in R-/D+.

Chagas Disease, Leishmaniasis, and Malaria in Solid Organ Transplant Recipients

“…The assessment of the risk of transmission of CD by organ transplantation from seropositive donor (D+) to seronegative recipient (R-) is based on a limited number of studies, which are generally retrospective and with short follow-up, as seen in Table 1 [21][22][23][24][25][26][27][28][29][30]. The average prevalence was 19.3%, ranging from 9.6% for kidney transplant, 17.1% for liver transplant, to 75% for heart transplant [24,[27][28][29][30]. It is worth noting that in Argentina, the prevalence of T. cruzi infection among effective donors doubled (from 2.46% to 4.6%) from 2005 to 2009 [31].…”

“…Risk of reactivation of T. cruzi infection varies according to the organ transplanted and the degree of drug immunosuppression, with the highest risk associated with heart transplantation (mean average of 44.9%) and similar risk for kidney (21.7%) and liver (33.3%) transplantation, as shown in Table 2 [30,[33][34][35][36][37][38][39][40][41][42][43][44][45][46][47]. The majority of the studies regarding reactivation came from Brazil and are related to patients who undergo heart transplantation, with a prevalence rate ranging from 23% to 90% [33][34][35][36][37][38][39][40][41]44].…”

“…Myocarditis and meningoencephalitis can run an aggressive course, rapidly leading to the death of the patients [58][59][60]. Nevertheless, the outcome and survival rate of SOT recipients who develop acute CD or reactivation of the disease, especially among heart transplant recipients monitored and treated promptly, is similar to patients not affected by CD and in some instances even better [23,30,33,36,37,46]. Among liver transplant recipients in Argentina, the median stay in intensive care, median hospital stay, rate of acute graft rejection, rate of infection, and rate of graft survival was similar in patients at risk of CD compared to the controls, with no deaths attributable to acute CD [30].…”

“…Nevertheless, the outcome and survival rate of SOT recipients who develop acute CD or reactivation of the disease, especially among heart transplant recipients monitored and treated promptly, is similar to patients not affected by CD and in some instances even better [23,30,33,36,37,46]. Among liver transplant recipients in Argentina, the median stay in intensive care, median hospital stay, rate of acute graft rejection, rate of infection, and rate of graft survival was similar in patients at risk of CD compared to the controls, with no deaths attributable to acute CD [30]. Mortality related to CD reactivation among HTx recipients has been reported in 0.3% to 0.7% of patients in Brazil and in 0% of patients in a recent study in the USA [33,40,46].…”

“…PCR shows a low sensitivity due to low parasitaemia during chronic infection and should not be used as a screening test [61]. On the contrary, PCR for T. cruzi performed on blood is currently considered the gold standard for post-transplant monitoring and early diagnosis of acute infection or reactivation [26,30,43]. Quantitative real-time PCR monitoring during the first 6 to 24 months post-transplant is actually recommended and employed in the centers transplanting the organs of Chagas disease patients [1,5,9,31,45].…”