Heart Transplantation in 107 Cases of Chagas' Disease
Carregando...
Citações na Scopus
74
Tipo de produção
article
Data de publicação
2011
Título da Revista
ISSN da Revista
Título do Volume
Editora
ELSEVIER SCIENCE INC
Autores
OLIVEIRA, A. S.
SILVA, M. F. A. da
AYOUB, F. L.
Citação
TRANSPLANTATION PROCEEDINGS, v.43, n.1, p.220-224, 2011
Resumo
Introduction. Chagas' disease is endemic in South America. Objective. This research reviewed the experience with cardiac transplantation in Chagas' disease, emphasizing reactivation, immunosuppression, and mortality. Methods. Over 25 years from March 1985 to March 2010, 107/409 (26.2%) patients with Chagas' disease underwent heart transplantation, patients including 74 (71.1%) men and 72 (67.2%), in functional class IV with 33 (30.8%) on vasopressors and 17 (10.7%) on mechanical circulatory support. Results. The diagnosis of disease reactivation was performed by identifying the parasite in the myocardium (n = 23; 71.8%) in the subcutaneous tissue (n = 8; 25.0%), in blood (n = 11; 34.3%), or in central nervous tissue (n = 1; 3.1%). Hospital mortality was 17.7% (n = 19) due to infection (n = 6; 31.5%), graft dysfunction (n = 6; 31.5%), rejection (n 4; 21.1%), or sudden death (n = 2; 10.5%). Late mortality was 27 (25.2%) cases, which were distributed as: rejection (n = 6; 22.2%), infection (n = 6; 22.2%), (n = lymphoma 4; 14.8%), sarcoma (n = 2; 7.4%), for constrictive pericarditis (n = 2; 7.4%) reactivation of Chagas' disease in the central nervous system (n = 1; 7.1%). Conclusions. Transplantation in Chagas' disease has peculiar problems that differ from other etiologies due to the possibility of disease reactivation and the increased possibility of emergence of cancers. However, transplantation is the only treatment able to modify the natural progression of the disease in its terminal phase. Early diagnosis and rapid introduction of benzonidazole reverses the histological patterns. Immunosuppression, especially steroids, predisposes to the development of cancer and disease reactivation.
Palavras-chave
Referências
- ALMEIDA DR, 1995, ARQ BRAS CARDIOL S1, V65, P1
- Bocchi EA, 2001, ANN THORAC SURG, V71, P1833, DOI 10.1016/S0003-4975(01)02587-5
- Bacal F, 2010, CLIN TRANSPLANT, V24, pE29, DOI 10.1111/j.1399-0012.2009.01202.x
- Assef MAS, 2001, REV BRAS CIR CARDIOV, V16, P289, DOI 10.1590/S0102-76382001000400003
- Bestetti RB, 2010, J HEART LUNG TRANSPL, V29, P1312, DOI 10.1016/j.healun.2010.06.010
- CARVALHO VB, 1996, CIRCULATION, V94, P1815
- Chagas Carlos, 1911, Memorias do Instituto Oswaldo Cruz, V3
- Develoux M, 2010, Med Trop (Mars), V70, P38
- Fiorelli AI, 2007, TRANSPL P, V39, P2527, DOI 10.1016/j.transproceed.2007.07.025
- Fiorelli AI, 2005, TRANSPLANT P, V37, P2793, DOI 10.1016/j.transproceed.2005.05.038
- Guerri-Guttenberg R A, 2009, Infez Med, V17, P5
- Milei J, 2009, AM HEART J, V157, P22, DOI 10.1016/j.ahj.2008.08.024
- Moreira Luiz Felipe P., 2005, Rev Bras Cir Cardiovasc, V20, P261, DOI 10.1590/S0102-76382005000300006
- Sarkar S, 2010, PLOS NEGLECT TROP D, V4, DOI 10.1371/journal.pntd.0000836
- VILA JHA, 1985, ARQ BRAS CARDIOL S1, V45, P1