Transplantation for Chagas Heart Disease: a Comprehensive Review

Chagas cardiomyopathy (CC) has a worse prognosis than other forms of cardiomyopathy and up to 10% of patients may progress to end-stage heart failure. In this article, we have performed a comprehensive literature review of heart transplantation (HT) for CC, including results after HT, management of immunosuppression, and Chagas disease (CD) reactivation. CD used to be considered a contraindication to HT due to the risks of disease reactivation with immunosuppression. Nonetheless, multiple reports have consistently demonstrated the feasibility and safety of HT for refractory CC. CD reactivation must be routinely screened in the first-year post-transplant, and in recent years, polymerase chain reactions (PCR)-based techniques have been used more often. HT is now considered the best treatment for end-stage Chagas heart disease. In addition, studies of immunosuppressive medications have shown that these patients require a lesser degree of immunosuppression, mainly to balance reactivation risks.