Introduction: Chagas disease poses a prevalent public health issue in Latin America, and the scarcity of transplant organs leads some centers to utilize T. cruzi-positive donors. Chagas transmission through the use of kidneys from infected donors ranges from 10 - 20% across different series, and robust evidence on the efficacy of prophylactic treatment is lacking. Our objective is to assess Chagas transmission from positive donors in kidney transplant recipients in highly endemic regions with routine benzonidazole prophylaxis for negative recipients post-transplant.
Methods: This is a retrospective observational study evaluating all kidney transplant recipients from seropositive donors for Chagas disease from January 1, 2013, to December 31, 2022.
Results: During the analysis period, 74 kidney transplants were performed from T. cruzi-infected donors; T. cruzi transmission occurred in 2 recipients (2.7%), with symptoms initiating in both patients 5 months after transplant, resulting in 1 fatality (1.35%). All patients received Benznidazole prophylaxis for 2 months, with only 1 (1.35%) using the medication for a shorter period, leading to transmission. Clinical presentation varied, including nonspecific thigh root edema, fever, worsened graft function, and a fulminant presentation with organ dysfunction and shock. Elevated lactate dehydrogenase was a common laboratory marker in both cases.
Conclusion: This is a large observational study of kidney transplants in T. cruzi seronegative recipients from T. cruzi-positive donors. With the increasing number of transplant candidates, benzonidazole prophylaxis offers secure use of organs from chronic chagasic donors, demonstrating promising results.