Liver Transplantation Using Chagas-Infected Donors in Uninfected Recipients: A Single-Center Experience Without Prophylactic Therapy

Abstract

Organ shortage is the first cause of death on liver transplant waiting lists. As a consequence, we recently decided to expand liver acceptance to those organs that could potentially transmit infectious diseases to their recipients. On January 2010, we initiated a prospective protocol using livers from Chagas-infected donors for transplanting uninfected recipients without using prophylactic therapy. During a 13-month period, 9 of 37 (24%) liver transplants were performed within this protocol. After transplant, each recipient was sequentially and strictly monitored for infection transmission using the Strout method and promptly treated with benznidazole if this occurs. During follow-up, two patients died without Chagas infection and only two (donorderived T. cruzi transmission rate: 2/9; 22%) patients developed donor-derived Chagas transmission without clinical symptoms. The median follow-up time of the seven live patients was 15 months (range: 13-20). At present, all are symptoms-free with excellent allograft function and without evidence of Chagas disease. In conclusion, we consider that Chagas-infected donors are a promising source of liver grafts that could reduce the growing mortality on liver waiting lists in America. Relevant data from larger prospective studies are required to confirm these preliminary excellent results.

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

“…In the reported investigations, intensive monitoring of recipients led to prompt recognition and treatment of transplant-associated T. cruzi infection. This evidence supports the recommendation that the liver and kidneys from seropositive donors may be transplanted provided the transplant center and recipients are committed to appropriate prospective monitoring and advance planning for potential therapy (10,20). Further investigation is needed to understand the risk for transmission and the factors that affect outcomes associated with transplantation of organs from T. cruzi infected donors, by organ type and recipient characteristics.…”

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

“…To our knowledge, this is the first study in which qPCR was prospectively used for early detection of T. cruzi reactivation during LT. We demonstrated a similar rate of postoperative complications (bacterial infections and graft rejection) and 1‐year graft survival in patients at risk of CD compared to those without risk of CD. Finally, as in other studies, no deaths were attributed to acute CD during follow‐up …”

“…After successful kidney transplants in T. cruzi‐ infected recipients and initial reports of liver transplantation (LT) using T. cruzi ‐infected donors, many transplant units have expanded donor criteria to include infected individuals . In these cases, early post‐transplant detection of T. cruzi is critical for a successful outcome in infected recipients and in those who receive organs from positive donors.…”

Trypanosoma cruzi Survival following Cold Storage: Possible Implications for Tissue Banking

“…The tissue distribution of T. cruzi in acute experimental infection of mice is extensive and involves virtually all tissues [22]–[26], but the extent to which T. cruzi persists in different tissue during chronic infection is poorly understood. A prospective study of 9 liver grafts transplanted from T. cruzi -infected donors to seronegative patients in Argentina showed only 2 parasitemia-positive outcomes in a one-year follow-up [27].…”