Trypanosoma cruzi persistence in the native heart is associated with high-grade myocarditis, but not with Chagas' disease reactivation after heart transplantation

Trypanosoma cruzi persistence in the native heart is associated with high-grade myocarditis, but not with Chagas' disease reactivation after heart transplantation

Author Benvenuti, Luiz A. Google Scholar
Roggerio, Alessandra Google Scholar
Nishiya, Anna S. Autor UNIFESP Google Scholar
Campos, Silvia V. Google Scholar
Fiorelli, Alfredo I. Google Scholar
Levi, Jose E. Autor UNIFESP Google Scholar
Institution Universidade de São Paulo (USP)
Universidade Federal de São Paulo (UNIFESP)
Abstract BACKGROUND: Chagas' disease reactivation (CDR) after heart transplantation (HTx) is characterized by relapse of the infectious disease, with direct detection of Trypanosoma cruzi parasites in blood, cerebrospinal fluid, or tissues. We investigated whether a detailed pathologic examination of the explanted heart at HTx with evaluation of myocarditis and parasitic persistence or load in the myocardium could be useful to identify patients at high risk of CDR.METHODS: the native hearts of 18 chagasic patients who presented CDR after HTx (CDR+ group) were compared with the native hearts of 16 chagasic patients who never presented CDR in a follow-up of at least 18 months after HTx (CDR- group). the intensity of myocarditis was evaluated semiquantitatively. Parasite persistence/load in the myocardium was investigated through immunohistochemistry for T cruzi antigens and by qualitative and quantitative real-time PCR for T cruzi DNA.RESULTS: the rate of high-grade myocarditis, parasite persistence, and the median of parasitic load and parasitic load/10(6) cells in the CDR+ group were 83.3%, 77.8%, 8.43 x 10(-3), and 9.890, respectively, whereas in the CDR- group the values were 87.5%, 50%, 7.49 x 10(-3), and 17.800. There was no statistical difference between the groups. High-grade myocarditis was present in all 22 samples (100%) with parasite persistence and in 7 of 12 samples (58.3%) with no parasite persistence (p = 0.003).CONCLUSIONS: Although associated with high-grade myocarditis, T cruzi parasite persistence in the myocardium of the native heart is not associated with the occurrence of CDR after HTx. (C) 2014 International Society for Heart and Lung Transplantation. All rights reserved.
Keywords Chagas' disease
Trypanosoma cruzi
heart transplantation
myocarditis
polymerase chain reaction
Language English
Sponsor Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)
Grant number FAPESP: 11/51580-1
Date 2014-07-01
Published in Journal of Heart and Lung Transplantation. New York: Elsevier B.V., v. 33, n. 7, p. 698-703, 2014.
ISSN 1053-2498 (Sherpa/Romeo, impact factor)
Publisher Elsevier B.V.
Extent 698-703
Origin http://dx.doi.org/10.1016/j.healun.2014.01.920
Access rights Closed access
Type Article
Web of Science ID WOS:000339532100005
URI http://repositorio.unifesp.br/handle/11600/37938

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