Infections in heart transplant recipients in Brazil: The challenge of Chagas' disease
published online 28 September 2009.
Background
Despite the high incidence of infections after heart transplantation, there is limited information about its epidemiology in patients from countries where Chagas' disease is endemic.
Methods
We analyzed the occurrence of infections in 126 patients aged older than 18 years who underwent transplantation from 1986 through 2007 at a Brazilian University Hospital and who survived at least 48 hours.
Results
Heart failure diagnoses before transplantation were idiopathic dilated cardiomyopathy (38.6%), Chagas' disease (34.9%), coronary artery disease (19.8%), and others (6.3%). The respiratory tract was the most common site of infections (40.9%), followed by surgical wound site (18.1%). Trypanosoma cruzi reactivations occurred in 38.8% of Chagas' disease patients: 47.0% had myocarditis, 23.5% had skin lesions, and 29.4% had both. New-onset ventricular dysfunction was observed in 47.0%, with complete response after specific treatment, and 41.0% were asymptomatic cases, diagnosed by routine endomyocardial biopsies. No patient died from such events. No differences in survival were found after 5 years of follow-up between recipients with and without Chagas' disease (p = 0.231).
Conclusions
In a heart transplant population from a developing country, infectious complications occurred at a high rate. Tropical illnesses were uncommon, except for the high rate of Chagas' disease reactivations. Despite that, the overall outcome of these patients was similar to that of recipients with other cardiomyopathies.
aDivision of Cardiology, Department of Medicine, Federal University of São Paulo, São Paulo, Brazil
bDivision of Infectious Disease, Department of Medicine, Federal University of São Paulo, São Paulo, Brazil
cDepartment of Surgery, Federal University of São Paulo, São Paulo, Brazil
dMedical Investigation Laboratory - Parasitology, Tropical Medicine Institute, University of São Paulo, São Paulo, Brazil
Reprint requests: Henrique L. Godoy, MD, Federal University of São Paulo Cardiology, Botucatu St, 740 10th Flr, 4023—900 São Paulo—SP, Brazil. Telephone: 55-11-55993669. Fax: 55-11-5599369
ABSTRACT