Liver Transplantation in Patients With Chagas Disease?
We have 2 patients on the waiting list for liver transplantation who tested positive for Chagas IgG; one of them had an undetermined PCR for Chagas awaiting for a second sample to be tested. I read that in Brazil they have performed kidney and heart transplantation on Chagas IgG+ patients, with relative success. Is evidence of Chagas exposure an absolute contraindication for liver transplantation?

Alvaro Gonzalez Koch, MD

Chagas disease has been reported to occur in Latin America after bone marrow and solid organ transplantation. In some countries, terminal heart disease from Chagas disease is one of the main indications for heart transplantation. However, many authors believe that heart transplantation is contraindicated in this condition because of reactivation of the disease. If not diagnosed in time, this protozoan disease caused by Trypanosoma cruzi can be lethal. Reactivation of Chagas disease and transmission from donors with previous exposure to seronegative organ recipients have both been reported. In one case report, meningoencephalitis secondary to Chagas disease occurred 8 years after kidney transplantation. This case illustrates the fact that reactivation may occur in immunosuppressed individuals. Transmission of Chagas for the first time in the United States after organ transplantation was recently reported.

Different investigators have shown that circulating trypomastigotes and tissue amastigotes are evidence of active Chagas disease. More recently, polymerase chain reaction has been evaluated as a tool for early diagnosis, and preemptive therapy with benznidazole has been successful in prevention of severe clinical disease.

Therefore, evidence of Chagas exposure could be considered a relative contraindication for organ transplantation. Obviously, if the risk of dying from liver disease is substantial, liver transplantation may be the only choice available, and careful monitoring for possible reactivation is indicated.