Liver Transplantation from Deceased Donors Serologically Positive for Chagas Disease

Abstract

The high mortality rates among patients waiting for liver transplantation has motivated the use of 'marginal livers', among which are included livers from deceased donors serologically positive for Chagas disease (CD). The present work describes the outcome of orthotopic liver transplantation in six patients with severe liver disease (Child Pugh C), with livers from donors serologically positive for CD. Transplantations were performed from November 2000 to January 2005, and the patients received prophylactic treatment with benznidazole for 60 days, as a recommended by the Brazilian Consensus in Chagas Disease. The transplantation procedures presented no technical problems, and all the patients were discharged from hospital. Five of them did not present side effects demanding interruption of the prophylactic treatment. Four of the patients were clinically well over 1 year after transplantation (mean follow-up of 42.1 months), with negative serological results for CD. Two patients died, one of them 6 months post surgery of sepsis due to biliary complication and other one due to pulmonary (tuberculosis) complications. They were both serologically negative for CD. These results suggest that liver transplantation from CD donors, followed by benznidazole prophylactic treatment, is an important therapeutic alternative for severe liver disease.

Donor-Derived Trypanosoma cruzi Infection in Solid Organ Recipients in the United States, 2001–2011

“…Although advocated by some authors (15,16,17), we agree with previously published guidelines that do not recommend chemoprophylaxis in transplant recipients from T. cruzi-seropositive donors. Our data suggest that preemptive monitoring identifies infection that can be treated before disease occurs.…”

2 nd Brazilian Consensus on Chagas Disease, 2015

“…Cases with immunodeficiency, including patients taking immunosuppressive drugs to treat neoplasms, transplants, and other diseases, and patients with T. cruzi/HIV co-infection, can develop reactivation of Chagas disease (181) (184) (304) . This is discussed, in themes, below.…”

Transmission of Tropical and Geographically Restricted Infections during Solid-Organ Transplantation

“…Both had negative serology for Chagas' disease. Based on the results, those authors maintain that the use of liver grafts from patients who were seropositive for Chagas' disease followed by prophylactic treatment with benznidazole may be a feasible therapeutic option for patients with severe liver disease (93).…”