Transmission ofT. cruzi infection via liver transplantation to a nonreactive recipient for Chagas' disease

Abstract

Chagas' disease is an endemic zoonosis of South America caused by a protozoan parasite Trypanosoma cruzi. About 30% of infected people develop the disease. This disease is known to reactivate in immunocompromised hosts, such as patients with acquired immunodeficiency syndrome, leukemia, and transplantation. There is some experience with transplantation of infected renal grafts into negative recipients, resulting in an index of transmission of 35%. No cases have been reported involving other organ transplants up to 2002, when the Centers for Disease Control and Prevention reported 3 cases of Chagas' disease transmission to 3 recipients (liver, kidney, and pancreas‐kidney) from a single chagas infected donor. Here we report on a case of orthotopic liver transplant from a chagas infected donor into a negative recipient in clinical emergency status. The recipient was monitored by direct parasitological Strout method and serological tests with detection of transmission on the 84th day by both studies, without clinical signs. The patient was put on benznidazole with rapid clearance of the parasitemia. However, we propose that chagas infected donors may be accepted for liver transplant recipients only in emergency status. (Liver Transpl 2005;11:1112–1116.)

2 nd Brazilian Consensus on Chagas Disease, 2015

“…The rate of reactivation in recipients of allogeneic hematopoietic stem cell (184) and liver (185) transplants is 27.3%, and 18.7%, respectively. The use of corticosteroids in association with increased parasitemia and a possible effect with immunosuppressive drugs to treat mesenchymal diseases have been recorded, without a well-defined causal relationship (186) .…”

Chagas disease in bone marrow transplantation: an approach to preemptive therapy

“…[25][26][27] The higher tendency to CD reactivation in BMT recipients, six out of 22 patients (27.3%), could be related to the degree of immunosuppression due to underlying diseases or transplantation. Moreover, in Allo-BMT, the intensity of the chemotherapy and/or radiotherapy plus the use of immunosuppressive drugs to avoid GVHD may have increased the risk of CD reactivation episodes in comparison to ABMT and solid-organ transplantation.…”

“…Two of the living related donors received prophylaxis with BZ for 30 days. Previous experiences in kidney 15 and liver transplants [25][26][27] suggest that grafts from CD donors have the potential to transmit CD infection. The experience gained in these previous studies sustained the suggestion of applying prophylaxis in CD-related living donors due to the importance of decreasing the potential inocula of T. cruzi parasites through the organ, in this case, the bone marrow.…”

Transmission of Tropical and Geographically Restricted Infections during Solid-Organ Transplantation

“…It is difficult to estimate the potential risk of transmission of T. cruzi in transplant patients. According to some authors, the rate of transmission is estimated to be around 35% when infected renal grafts are used in seronegative patients (19). For other types of transplantation, consistent figures are not available due to the decreased number of cases.…”

“…Treatment was commenced with benznidazole, with rapid elimination of parasitemia. Those authors recommended that T. cruzi-infected grafts should be used only in emergency situations (19). However, another article published in 2007 identified six patients who received a liver graft from donors who were seropositive for Chagas' disease at a specific unit during the period of 2000 to 2005: all but one of the patients (because of drug intolerance) received prophylactic benznidazole treatment for 60 days following transplantation.…”