Reactivation of Chagas Disease in the Central Nervous System Among Heart Transplant Recipients: A Clinical Series From Brazil, 2006-2023.

BACKGROUND

Chagas disease is a relevant cause of heart transplantation. The risk of reactivation is a potential concern. This study aimed to describe the reactivation of Trypanosoma cruzi in the central nervous system (CNS).

METHODS

We performed a retrospective study of all heart transplants for Chagas disease undertaken between 2006 and 2023 at a single institution in Brazil to define the prevalence of neurological reactivation and reviewed clinical characteristics and outcomes associated with CNS T. cruzi involvement.

RESULTS

Among 187 Chagas disease recipients, 11 episodes of neurologic reactivation were identified in nine patients, at a median of 160 days after transplant. Two patients had a relapse more than a year after the first episode. Three patients died and the remaining six had neurological sequelae. Of the 11 episodes of CNS reactivation, eight were confirmed based on finding T. cruzi parasites or DNA in cerebrospinal fluid or brain tissue biopsy, the remaining three episodes were considered probable by demonstrating parasites in blood and other tissues. Focal neurological manifestations (8 of 11 episodes) and a single lesion with the predominant involvement of white matter (6 of 11 episodes) were the most common features. Brain biopsy was the gold standard tool, detecting five of seven CNS reactivation. T. cruzi PCR in cerebrospinal fluid confirmed two of three cases, and direct examination has a low diagnostic yield, detecting only one of six episodes.

CONCLUSION

Neurological Chagas reactivation is a rare and severe posttransplant complication that should be considered in any at-risk heart recipient.