Liver and Kidney Transplantation With Organs From Trypanosoma cruzi-positive Donors: A Valuable Resource That Requires Close Monitoring

BACKGROUND: To increase organ availability in areas with low transplant access, the use of deceased donors infected with Trypanosoma cruzi for liver and kidney transplantation has been adopted, balancing the risk of transmission. This Argentinean study aimed to analyze the reactivation rate and safety of this practice. METHODS: This study combined 2 complementary approaches: a cross-sectional analysis of the Argentinean Transplant Registry (2006-2020) and a retrospective multicenter cohort study of solid organ transplant recipients. The cohort study was designed to assess the risk of donor-derived T. cruzi infection in liver and kidney transplant recipients across Argentina. RESULTS: The cross-sectional analysis identified a seroprevalence of 3.52% (528/14 966) among deceased donors. Data were obtained from 129 recipients who received an organ from a T. cruzi-positive donor. With a median follow-up of 3.62 y, and high adherence to surveillance (83%), T. cruzi infection was diagnosed in 22% of recipients, with a median time of 57.5 d posttransplant. Seventy-five percent (n=21/28) of the patients remained asymptomatic. Neither prior T. cruzi seropositivity in the recipient (odds ratio, 0.27; 95% confidence interval, 0.01-4.89; P = 0.200) nor a history of rejection (odds ratio, 0.63; 95% confidence interval, 0.19-2.12; P = 0.452) was significantly associated with Chagas reactivation. Almost all infected patients received benznidazole, and the infection resolved without sequelae in those treated. The treatment was well tolerated. Chagas disease was never identified as the cause of death. CONCLUSIONS: The use of T. cruzi-positive donors for liver and kidney transplantation is safe, but requires careful monitoring, especially during the first year posttransplant.