Pathogenesis of Chagas Disease: an Emphasis for Transplant Patient Populations

Purpose of Review: Chagas disease is a neglected tropical disease that affects millions of people in the Americas. Reactivation of the infection can occur in the immunosuppressed host, often after organ transplantation. This article aims to review the pathogenesis of Chagas disease with special emphasis on transplant populations in an effort to inform clinicians about the potential risk for reactivation of Chagas disease in high-risk populations. Recent Findings: Reactivation of Chagas disease is most common in the recipient who had Chagas cardiomyopathy and least common in the recipient of non-heart tissues from Chagas patients. T cell suppression associated with AIDS and transplantation is a major risk factor for reactivation. Certain drugs are associated with a higher risk for reactivation post-transplant, such as mycophenolate motefil. TNF-α inhibitors may also be associated with reactivation of Chagas disease. Routine PCR after transplantation seems to be an adequate tool for early diagnosis after transplant. Summary: Transplant physicians should be aware of Chagas disease as a potential transmission risk for donors originating from endemic areas. The highest transmission risk being in cardiac donors and lesser risk for liver and kidney donors. Standardized monitoring protocols seem to detect the infection early, reducing the risk for complications from reactivation of Chagas disease in this population.