The Case of a Liver Transplant Infected with T. cruzi

The journal Clinical Microbioliogy and Infection has published the case of a woman that received a T. cruzi infected liver and that showed favourable evolution despite not having received preventive treatment against the infection. The case, reported by a medical team from the Hospital Universitario Central de Asturias, Oviedo, led by Dr. Azucena Rodriguez-Guardado with the support of Dr. J. Gascon from ISGlobal and Dr. M. Flores of the Instituto Carlos III, underlines the urgent need for the unification of European policies regarding the use of organs from T. cruzi infected donors.   

The shortage of suitable organs for transplantation has encouraged the use of organs from donors with transmissible infections such as Chagas Disease. In that case, the organ recipient receives a pre-emptive treatment against the parasite or is closely monitored during several months and receives treatment in case infection by the parasite (Trypanosoma cruzi) is detected. In the reported case, the liver recipient did not receive the preventive treatment because infection of the donor was communicated 10 months after the graft. In that moment, the medical team confirmed infection by different laboratory tests and initiated treatment with the antiparasitic drug benznidazole. During the whole treatment and follow-up period, the grafted woman did not develop any symptom of the disease and managed to clear the parasite. For the authors, it is remarkable that the patient remained asymptomatic for nine months after transplantation despite the use of immunosuppressants.  They conclude that the livers of T. cruzi-positive donors can be used for patients in terminal stages of their illness as long as the risk is known and the appropriate measures are taken.   

Of the 8 to 10 million people infected with T. cruzi worldwide, 100.000 live in Europe, particularly in Spain. Even though the disease-transmitting vector is not endemic in Europe, transmission can still occur via blood transfusions, organ transplants and from mother to child. Thus, a unification of European policies regarding the screening and use of organs from infected donors is necessary and urgent.   

Reference:

Rodriguez-Guardado A, González ML, Rodriguez M, Flores-Chavez M, Boga JA, Gascon J.Trypanosoma cruzi infection in a Spanish liver transplant recipient. Clin Microbiol Infect.2015; Apr 13