The paradox of survival results after heart transplantation for cardiomyopathy caused by Trypanosoma cruzi

Background. Donor supply limits heart transplantation (HT) and relative pri ority should be given to cases with greater chances of success. The objecti ves of this multicenter study were (1) to determine the survival rate after heart transplantation for patients with Chagas' heart disease (ChHD) in co mparison with other causes; and (2) to identify the causes of death specifi cally due to reactivation of the Trypanosoma cruzi infection. Methods. We studied 720 patients who had undergone orthotopic heart transpl antation and were followed in 16 heart transplantation centers. The etiolog y was idiopathic dilated cardiomyopathy in 407 patients, ischemic cardiomyo pathy in 196 patients, and ChHD in 117 patients. Results. Follow-up was 2.87 +/- 3.05 years (from 1 month to 13.85 years). S urvival of ischemic recipients at 1, 4, 8, and 12 years was 59%, 44%, 34%, and 22%, respectively; for idiopathic dilated cardiomyopathy it was 69%, 57 %, 40%, and 32%; and for ChHD it was 71%, 57%, 55%, and 46% (p < 0.027). In ischemic recipients the most frequent causes of death were infection (15.3 %), acute graft failure (13.3%), and graft coronary artery disease/sudden d eath (7.7%). In idiopathic dilated cardiomyopathy the causes were infection (11.1%), rejection (9.6%), and acute graft failure (9.1%). In ChHD the cau ses were infection (10.3%), rejection (10.3%), and neoplasm (4.3%). In ChHD , reactivation of the cruzi infection was the cause of death in 2 patients. Conclusions. The survival results after heart transplantation are paradoxic al according to the usually high expected death rates for Chagas' disease. Heart transplantation for ChHD should be regarded as a valuable treatment o ption.