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Ann Thorac Surg 1996;61:1727-1733
© 1996 The Society of Thoracic Surgeons
Heart Institute, São Paulo University Medical School, São Paulo, Brazil
Accepted for publication February 6, 1996.
Background. Chagas' disease has been considered a contraindication to heart transplantation as Trypanosoma cruzi infection could recur after immunosuppression.
Methods. We report the follow-up of 22 patients who underwent orthotopic heart transplantation for treatment of end-stage chronic Chagas' heart disease, divided in two groups. Group 1 consisted of 9 patients operated on from September 1985 to June 1991, and group 2 patients underwent transplantation from July 1991 Aug 91 in text to June 1995. After our early experience with group 1, we attempted to use a lower cyclosporine dosage in group 2.
Results. Total actuarial survival at 24 months was 60%, and it was better for group 2 (33% for group 1, 80% for group 2, p = 0.008). Parasitemia occurred similarly in both groups, but Chagas' disease reactivation was seen in 5 group 1 patients and in 1 group 2 member (p < 0.002). Neoplasia developed in 5 group 1 patients and 1 group 2 patient, and contributed to death in 3 of them.
Conclusions. These data demonstrate satisfactory outcome of cardiac transplantation in patients with end-stage Chagas` heart disease in the second phase of our experience. Further progress is necessary to improve the results and evaluate its proper role in the management of this disease.
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