Donor-Derived Trypanosoma cruzi Infection in Solid Organ Recipients in the United States, 2001-2011

: Although Trypanosoma cruzi, the parasite that causes Chagas disease, can be transmitted via organ transplantation, liver and kidney transplantation from infected donors may be feasible. We describe the outcomes of 32 transplant recipients who received organs from 14 T. cruzi seropositive donors in the United States from 2001 to 2011. Transmission was confirmed in 9 recipients from 6 donors, including 3 of 4 (75%) heart transplant recipients, 2 of 10 (20%) liver recipients and 2 of 15 (13%) kidney recipients. Recommended monitoring posttransplant consisted of regular testing by PCR, hemoculture, and serology. Thirteen recipients had no or incomplete monitoring; transmission was confirmed in five of these recipients. Four of the five recipients had symptomatic disease and all four died although death was directly related to Chagas disease in only one. Nineteen recipients had partial or complete monitoring for T. cruzi infection with weekly testing by PCR, hemoculture and serology; transmission was confirmed in 4 of 19 recipients with no cases of symptomatic disease. Our results suggest that liver and kidney transplantation from T. cruzi seropositive donors may be feasible when the recommended monitoring schedule for T. cruzi infection is followed and prompt therapy with benznidazole can be administered. (C) 1999?2012 John Wiley & Sons, Inc; References: 1. Kun H, Moore A, Mascola L, et al. Transmission of Trypanosoma cruzi by heart transplantation. Clin Infect Dis, 2009; 48: 1534-1540. 2. Bern C, Montgomery SP, Herwaldt BL, et al. Evaluation and treatment of Chagas disease in the United States: A systematic review. JAMA, 2007; 298: 2171-2181. 3. Organizacion Panamericana de la Salud. Estimacion cuantitativa de la enfermedad de Chagas en las Americas. Montevideo, Uruguay: Organizacion Panamericana de la Salud, 2006. 4. Dias JC, Silveira AC, Schofield CJ.. The impact of Chagas disease control in Latin America: A review. Mem Inst Oswaldo Cruz, 2002; 97: 603-612. 5. Bern C, Montgomery SP.. An estimate of the burden of Chagas disease in the United States. Clin Infect Dis, 2009; 49: e52-e54. 6. Cantey PT, Stramer SL, Townsend RL, et al. The United States Trypanosoma cruzi Infection Study: Evidence for vector-borne transmission of the parasite that causes Chagas disease among United States blood donors. Transfusion, 2012; 52: 1922-1930. 7. Bern C, Kjos S, Yabsley MJ, Montgomery SP.. Trypanosoma cruzi and Chagas' disease in the United States. Clin Microbiol Rev, 2011; 24: 655-681. 8. Centers for Disease Control and Prevention (CDC). Chagas disease after organ transplantation-United States, 2001. MMWR, 2002; 51: 210-212. 9. Centers for Disease Control and Prevention (CDC). Chagas disease after organ transplantation-Los Angeles, California, 2006. MMWR, 2006; 55: 798-800. 10. Chin-Hong PV, Schwartz BS, Bern C, et al. Screening and treatment of Chagas disease in organ transplant recipients in the United States: Recommendations from the Chagas in transplant working group. Am J Transplant, 2011; 11: 672-680. 11. Sturm NR, Degrave W, Morel C, Simpson L.. Sensitive detection and schizodeme classification of Trypanosoma cruzi cells by amplification of kinetoplast minicircle DNA sequences: Use in diagnosis of Chagas' disease. Mol Biochem Parasitol, 1989; 33: 205-214. 12. Virreira M, Torrico F, Truyens C, et al. Comparison of polymerase chain reaction methods for reliable and easy detection of congenital Trypanosoma cruzi infection. Am J Trop Med Hyg, 2003; 68: 574-582. 13. Qvarnstrom Y, Schijman AG, Veron V, Aznar C, Steurer F, da Silva AJ.. Sensitive and specific detection of Trypanosoma cruzi DNA in clinical specimens using a multi-target real-time PCR approach. PLoS Negl Trop Dis, 2012; 6: e1689. 14. Chagas' Disease Argentine Collaborative Transplant Consortium, Casadei D. Chagas' disease and solid organ transplantation. Transplant Proc, 2010; 42: 3354-3359. 15. D'Albuquerque LA, Gonzalez AM, Filho HL, et al. Liver transplantation from deceased donors serologically positive for Chagas disease. Am J Transplant, 2007; 7: 680-684. 16. Ortiz AM, Troncoso P, Sainz M, Vilches S.. Prophylaxis and treatment of Chagas disease in renal transplant donor and recipient: Case report. Transplant Proc, 2010; 42: 393-394. 17. Salvador F, Len O, Molina I, et al. Safety of liver transplantation with Chagas disease-seropositive donors for seronegative recipients. Liver Transpl, 2011; 17: 1304-1308. 18. Amato Neto V.. [Heart transplantation: donor with Chagas' disease and clinical course of the receptor]. Rev Hosp Clin Fac Med Sao Paulo, 1992; 47: 92. 19. Schwartz BS, Paster M, Ison MG, Chin-Hong PV.. Organ donor screening practices for Trypanosoma cruzi infection among US organ procurement organizations. Am J Transplant, 2011; 11: 848-851. 20. McCormack L, Quinonez E, Goldaracena N, et al. Liver transplantation using Chagas-infected donors in uninfected recipients: A single-center experience without prophylactic therapy. Am J Transplant, 2012; 12: 2832-2837.