Difference between revisions of "Chagas disease surgery"

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==Overview==
 
==Overview==
Surgery is not indicated in the treatment of Chagas disease.
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Surgery is not indicated in the treatment of Chagas disease. Chagas disease is not a contraindication for heart transplantation.  
 
==Surgery==
 
==Surgery==
Surgery is not indicated in the treatment of Chagas disease.
+
Heart transplantation is not considered a contraindication for heart transplantation. Despite the risk of T cruzi reactivation after transplantation and immunosuppression, universal “prophylactic” antitrypanosomal therapy is not recommended. Quantitative T cruzi PCR provides sufficient sensitivity to detect a reactivation before complications such as allograft dysfunction develop. Benznidazole has been the drug of choice for the treatment of T cruzi reactivations. Because treatment does not result in a cure of chronic T cruzi infection, patients remain vulnerable to new episodes of reactivation, and lifelong T cruzi monitoring is required. Immunosuppression after heart transplantation should be considered for patients with chagas cardiomyopathy. Use of lower immunosuppressive regimens has demonstrated fewer reactivations and improved outcomes, with no increase in allograph rejection in patients with CCC<ref name="pmid24165397">{{cite journal| author=Kransdorf EP, Czer LS, Luthringer DJ, Patel JK, Montgomery SP, Velleca A | display-authors=etal| title=Heart transplantation for Chagas cardiomyopathy in the United States. | journal=Am J Transplant | year= 2013 | volume= 13 | issue= 12 | pages= 3262-8 | pmid=24165397 | doi=10.1111/ajt.12507 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24165397  }}</ref>
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==References==
 
==References==
 
{{reflist|2}}
 
{{reflist|2}}

Latest revision as of 22:19, 14 February 2020

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Overview

Surgery is not indicated in the treatment of Chagas disease. Chagas disease is not a contraindication for heart transplantation.

Surgery

Heart transplantation is not considered a contraindication for heart transplantation. Despite the risk of T cruzi reactivation after transplantation and immunosuppression, universal “prophylactic” antitrypanosomal therapy is not recommended. Quantitative T cruzi PCR provides sufficient sensitivity to detect a reactivation before complications such as allograft dysfunction develop. Benznidazole has been the drug of choice for the treatment of T cruzi reactivations. Because treatment does not result in a cure of chronic T cruzi infection, patients remain vulnerable to new episodes of reactivation, and lifelong T cruzi monitoring is required. Immunosuppression after heart transplantation should be considered for patients with chagas cardiomyopathy. Use of lower immunosuppressive regimens has demonstrated fewer reactivations and improved outcomes, with no increase in allograph rejection in patients with CCC[1]

References

  1. Kransdorf EP, Czer LS, Luthringer DJ, Patel JK, Montgomery SP, Velleca A; et al. (2013). "Heart transplantation for Chagas cardiomyopathy in the United States". Am J Transplant. 13 (12): 3262–8. doi:10.1111/ajt.12507. PMID 24165397.

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