2357. Trypanozoma cruzi infection in patients undergoing solid organ transplantation
Session: Poster Abstract Session: Transplant Infections - Epidemiology
Saturday, October 7, 2017
Room: Poster Hall CD
Posters
  • Poster ID week 2017 Chagas 30-09.pdf (539.4 kB)
  • Background:

    It is estimated that 1.5 million people are infected with T. Cruzi in Argentina (4%). Chagas reactivation rate (R) in patients (pt.) with solid organ transplantation (SOT) is around 33%, being higher in cardiac transplantation (Tx). Objective: To describe the clinical characteristics, evolution, mortality, to evaluate reactivation risk factors and to analyze the usefulness of molecular tests in pt undergoing at SOT with Chagas' disease risk (ChR) (R or Donor- derived transmission, -DT-), in a hospital in our country.

    Methods:

    Retrospective cohort from all the pt. who received a SOT in our hospital from January 1988 to March 2017. All pt. with ChR: either R or DT were analyzed. Inclusion: survival more 30 d and 6 m of follow-up or until death. We performed post-Tx monitoring with parasitaemia (Strout), and serial whole blood polymerase chain reaction (PCR) testing, weekly until 2 m, every 2 weeks until the 6th m and monthly until the year, later annual. PCR monitoring is done since 2006.

    Results:

    We performed 1932 SOT in 29 years: 54 SOT in pt. with ChR, 46 chagasic recipients (CR) and 8 chagasic donors (CD) to negative recipient 24/46 (52%) presented R, (see table 1), 4 had more than one episode (ep.). Time to first R was 67 d (r: 3-296, median 30 d).

    At the time of the R Strout was performed in 19 ep. 13 were negative, PCR was positive in 10/10 of perfcormed test, 32% vs 100% (p = 0.001). Clinical R: 5 ep. in 4 pt. (panniculitis 3, 1 with myocarditis, 1 myocarditis). Strout was negative in 2 of these, in the other ep. monitoring had not been performed.

    Immunosuppression (IS): there were no differences in the IS, (induction and treatment of rejections).

    Reactivation: 21/24 responded to treatment, 2 spontaneously PCR-negative, 1 died. Mortality: 6/24 (25%) in pt. R and 2/17 (12%) in pt no R (p = ns), not related mortality. DT occurred in 1/ 3 liver and in 0/5 renal recipients.
    Type of Tx All Reactivation Clinic
    Liver (L) 786 7/26 (27%) 1/7 (14%)
    Heart 241 13/23 (56%) 2/13 (15%) 
    Kidney (K) 613 2/5 (40%) 1/2 (50%)
    Lung 105 1/2 (50%) 0
    LK 26 1/1 (100% 0
    Others 161 0 0

    Conclusion:

    PCR was more sensitive than Strout for detection of R or transmission. There was no clinical R in pt monitored by PCR. Also PCR sensitivity allow safe acceptance of Chagasic organs.

    Noelia Mañez, MD infectious diseases fellow1, Manuel Alderete Jr., MD2, Jose Benso, MD2, Alejandra Valledor, Infectious Diseases Specialist2, Astrid Smud, MD Infectious Diseases specialist1, Alejandro Schijman, Ph.D3, Susana Besuschio, Chem3 and Laura Barcan, MD infectious diseases specialist1, (1)Internal Medicine, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina, (2)Hospital Italiano de Buenos Aires, Buenos Aires, Argentina, (3)Instituto INGEBI, Buenos Aires, Argentina

    Disclosures:

    N. Mañez, None

    M. Alderete Jr., None

    J. Benso, None

    A. Valledor, None

    A. Smud, None

    A. Schijman, None

    S. Besuschio, None

    L. Barcan, None

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 4th with the exception of research findings presented at the IDWeek press conferences.