Clinical heart transplantationComparative histopathology of endomyocardial biopsies in chagasic and non-chagasic heart transplant recipients
Section snippets
Population
We studied 33 patients who underwent orthotopic heart transplantation over a period of 5 years. 18 patients were C and 15 NC. NC patients had dilated cardiomyopathy (n = 13), ischemic myocardiopathy (n = 1), and congenital heart disease (n = 1). 22 patients were male (11 C and 11 NC) and 11 were female (7 C and 4 NC) 14 to 63 years old, all of whom had NYHA functional class III or IV heart failure. The donors were serologically tested for Chagas’ disease (hemagglutination and indirect
General findings
In both groups there was a predominance of male patients (61.1% in the C and 73.3% in the NC group), with a similar distribution in both groups (p = 0.458). Moreover, there was no difference in the C and NC groups concerning patient age (mean age 37.6 years in the C group and 41.4 in the NC group, p = 0.238).
Endomyocardial biopsies
A total of 293 EMBs were analyzed, with a mean of 9 biopsies per patient (range 1 to 16).
Discussion
Chagas’ disease, particularly its pathogenesis, has been the subject of many investigations. Cardiac involvement frequently causes severe cardiac failure with a poorer prognosis compared to cardiomyopathy of other etiologies.18 Recently, heart transplantation has become a good therapeutic option for terminal patients, despite the possibility of recurrent infectious disease.5, 6
Experience accumulated over the years has led to improved survival, stimulating the increasing number of heart
Acknowledgements
This work was partially supported by a FAPESP and CNPq grants. The authors thank Dr. Maria de Lourdes Higuchi, Dr. Maria Regis Silva, Angela T. Paes, Dr. Venâncio Alves and Dr. Maria Teresa Seixas for help in the histopathological study and statistic analysis.
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Unexpected case of chagas disease reactivation in endomyocardial biopsy for evaluation of cardiac allograft rejection
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2018, Transplantation ReviewsCitation Excerpt :However, over-immunosuppression secondary to unbalanced immunosuppression regimens that are based on drugs with greater anti-proliferative mechanisms (i.e., mycophenolate mofetil) and high steroids doses, play a central role in the pathogenesis of T. cruzi reactivation [6]. The mechanism that connects over-immunosuppression to infection reactivation is not completely understood [41–44]. However, it has been proposed that the downregulation of T-helper 1 protective phenotypes makes the host susceptible to reactivation by allowing the quiescent amastigotes to reestablish its replicative process in multiple organ reservoirs (i.e., adipose tissue, adrenal gland, skeletal muscle, and bone marrow) and the cycle of parasitemia and systemic parasitism [3,8,41].
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2018, Cardiovascular Magnetic Resonance: A Companion to Braunwald’s Heart DiseaseChagas disease in the immunosuppressed patient
2014, Clinical Microbiology and InfectionCitation Excerpt :This condition has become, over time, the second to third leading cause of heart transplantation in Brazil [23,28]. Reactivation has been reported to occur in 26.5% [29] to 42.9% [22] of patients. Reactivation ranges from asymptomatic parasitaemia to fever, subcutaneous involvement, and myocarditis, and is more frequent in but not limited to the first post-transplant year [23].
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2010, Journal of Heart and Lung TransplantationCitation Excerpt :In our study, only direct observation of the parasite in blood cultures or in biopsy specimens with inflammatory response were considered as evidence of reactivation. This is an important issue for therapeutic decisions, because myocarditis caused by reactivation is clinically and histologically indistinguishable from rejection.22 The use of polymerase chain reaction to detect T cruzi reactivation may be helpful for monitoring patients at risk, but further clinical studies are necessary.23
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