Comparative in-hospital outcomes of heart transplant recipients with and without chagas disease in the United States: a nationwide analysis

Background Chagas disease (CD), a neglected disease caused by Trypanosoma cruzi, is a leading cause of cardiomyopathy in endemic countries and increasingly recognized in non-endemic countries like the United States. Heart transplantation (HT) is a life-saving measure in patients with end-stage Chagas cardiomyopathy. However, there has been controversy regarding the use of HT on these patients and there is unfortunately limited evidence regarding post-HT outcomes in patients with end-stage CD in non-endemic regions. Purpose We aim to assess the clinical profile and acute clinical outcomes of HT patients with CD compared to those without CD in the US. Methods We performed a retrospective analysis using the National Inpatient Sample from 2016 to 2021 to compare the baseline characteristics and hospital outcomes of 16,442 estimated HT admissions, including 116 with end-stage CD. Survey weights, strata, and clustering were incorporated using the survey package in R to generate nationally representative estimates Results We found no significant differences in in-hospital mortality (4.3% vs. 5.0%; p = 0.879) and clinical outcomes, including primary graft failure (17.4% vs. 13.6%; p=0.595), or acute rejection (4.3% vs. 3.2%; p=0.749), in CD recipients. However, CD patients had higher healthcare-associated costs ($1,292,810 ± $798,757 vs. $1,143,960 ± $1,042,981, p=0.029) and required home health care more frequently upon discharge (63.6% vs 39.4%, p<0.001). Conclusions These findings supports HT’s feasibility in CD in non-endemic countries, underscoring the relevance of specialized management of this population these settings. Further studies assessing long-term outcomes in these contexts are required.Figure 1.Temporal trends in CD HT.