Stolf N A, Higushi L, Bocchi E, Bellotti G, Auler J O, Uip D, Amato Neto V, Pileggi F, Jatene A D
Department of Cardiovascular Surgery, Instituto Do Coracao, University of São Paulo Medical School, Brazil.
J Heart Transplant. 1987 Sep-Oct;6(5):307-12.
Among 26 heart transplant patients, four had Chagas' disease cardiomyopathy. They were male patients, aged 28 to 43 years; three were in New York Heart Association class IV, and one was in class II but with refractory arrhythmias. The immunosuppressive protocol was cyclosporine and steroids in the first patient, and cyclosporine, azathioprine, and steroids in the last patient. Three patients had one or more rejection episodes, and one had none. One patient had a lymphoproliferative intestinal disease. Three patients had a new acute phase of Chagas' disease in postoperative days 59, 81, and 420, with fever, skin lesions, and myocarditis. The Trypanosoma cruzi was found in skin lesions in all three patients and in the myocardial biopsy in two patients. The laboratory tests did not show the expected results for the acute phase. All the alterations were reversed by specific therapy in a few days. One patient died on postoperative day 197 from rejection, and the immunosuppression was diminished because of the lymphoproliferative disease; the others were well 107, 160, and 500 days after the transplantation. The conclusions were as follows: (1) It seems that steroid pulse therapy predisposes the patient to a new acute phase of Chagas' disease. (2) Clinical presentation and laboratory test results of the acute phase are not the usual. (3) Specific drug therapy reverses all the alterations of this acute phase in a few days. (4) Although additional care is necessary and specific complications are expected, heart transplantation can be done with good results in patients with Chagas' cardiomyopathy.
在26例心脏移植患者中，4例患有恰加斯病性心肌病。他们均为男性患者，年龄在28至43岁之间；3例属于纽约心脏协会心功能IV级，1例为II级但伴有难治性心律失常。免疫抑制方案方面，首例患者采用环孢素和类固醇，最后一例患者采用环孢素、硫唑嘌呤和类固醇。3例患者发生了一次或多次排斥反应，1例未发生排斥反应。1例患者患有淋巴增生性肠道疾病。3例患者在术后第59天、81天和420天出现了恰加斯病的新急性期，伴有发热、皮肤病变和心肌炎。在所有3例患者的皮肤病变中均发现了克氏锥虫，2例患者的心肌活检中也发现了该病原体。实验室检查结果未显示出急性期的预期表现。所有这些改变在数天内通过特异性治疗得以逆转。1例患者在术后第197天因排斥反应死亡，由于淋巴增生性疾病，免疫抑制治疗有所减少；其他患者在移植后107天、160天和500天情况良好。结论如下：（1）似乎类固醇脉冲疗法使患者易患恰加斯病的新急性期。（2）急性期的临床表现和实验室检查结果并不常见。（3）特异性药物治疗在数天内可逆转急性期的所有改变。（4）尽管需要额外护理且预期会出现特定并发症，但对于恰加斯病性心肌病患者，心脏移植仍可取得良好效果。
