Prophylaxis for Chagas Disease Reactivation: Is it Necessary?

Purpose Chagas disease (CD) is caused by the parasite T cruzi and may reactivate in immunosuppressed transplant recipients. The incidence of CD has increased in Southern California as patients with Chagas cardiomyopathy may progress to require heart transplantation. While there are prophylactic medications for CD, is it not clear whether this prophylaxis prevents CD reactivation. Methods We reviewed 13 recipients transplanted between 1999 and 2019 who had CD prior to transplant. These patients had CD serologies checked at 1, 3, 6, 12 months post-transplant. 7 had T cruzi IgG antibodies and were given nifurtimox (n=2) or benznidazole (n=5). The other 6 did not develop antibodies and were not given antimicrobial therapy. Outcomes were compared: symptomatic CD, 1-year survival, freedom from rejection [any-treated (ATR), acute cellular (ACR) and antibody-mediated rejections (AMR)]. Results The patients who received antimicrobial therapy had numerically better 1-year survival. There was no difference in 1-year rejection (Table). Of the 7 patients who received antimicrobial therapy, none had CD reactivation while 3 patients in the no-prophylaxis group had CD reactivation. Conclusion Heart transplant patients with a history of CD appear to have acceptable outcome when closely monitored and administered antimicrobial therapy when indicated. Administration of prophylactic antimicrobial therapy to all CD, even without IgG antibodies, may be considered.