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Chagas disease and liver transplantation: Experience in Argentina using real‐time quantitative PCR for early detection and treatment
Author(s) -
Balderramo Domingo,
Bonisconti Florencia,
Alcaraz Alvaro,
Giordano Enzo,
Sánchez Ariel,
Barrabino Martín,
Caeiro Juan Pablo,
Alvarellos Teresita,
Maraschio Martín
Publication year - 2017
Publication title -
transplant infectious disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.69
H-Index - 67
eISSN - 1399-3062
pISSN - 1398-2273
DOI - 10.1111/tid.12782
Subject(s) - medicine , chagas disease , real time polymerase chain reaction , liver transplantation , transplantation , disease , immunology , gene , biochemistry , chemistry
Background Chagas disease ( CD ) is an endemic zoonosis that occurs in Latin America and is caused by the parasite T rypanosoma cruzi . Early detection of T . cruzi in liver transplant recipients at risk may avoid complications from CD . The aim of this study was to examine the pre‐operative evaluation and follow‐up of CD after liver transplantation ( LT ) of patients at risk of CD using real‐time quantitative polymerase chain reaction ( qPCR ) for T . cruzi . Methods Between January 2009 and June 2016, 13 (12.7%) of 102 LT s performed in recipients at risk for CD without specific postoperative prophylaxis were prospectively evaluated using qPCR for T . cruzi . Four seronegative patients received livers from seropositive donors (R−/D+) and 9 seropositive recipients received livers from seronegative donors (R+/D−). A cohort of 89 patients without risk for CD during the same time period was analyzed as controls. Results A positive qPCR for T . cruzi prior to LT was found in 2/9 (22.2%) seropositive recipients, and both achieved early response after therapy. The cumulative incidence of positive parasitemia after LT was higher in R+/D− than R−/D+ (37.7% vs 0%, P = .17). R+/D− transplant patients with positive qPCR achieved therapeutic response without manifestations of acute CD . LT outcomes at 1 year were similar in patients at risk of CD and in controls not at risk for CD. Conclusion A small proportion of T . cruzi ‐seropositive candidates presented positive parasitemia before LT . After LT , qPCR allowed detection of parasitemia leading to use of preemptive therapy in all R+/D− with T . cruzi replication. No cases of T . cruzi parasitemia occurred in R−/D+.