Screening and Reactivation of Chagas Disease Among Solid Organ Transplant Candidates and Recipients: A 10‐Year Single Center Experience in Florida

BACKGROUND: Chagas disease (CD), a neglected tropical disease usually associated with Latin America, is increasingly recognized as an emerging infection in the United States. Screening for CD is recommended for solid organ transplant (SOT) candidates with epidemiologic risk factors; however, data on prevalence and post-transplant reactivation in the United States remain limited. METHODS: We conducted a retrospective cohort study of SOT candidates and recipients screened for T. cruzi at a large transplant center in Miami, Florida. Demographics, clinical characteristics, and 2-year outcomes of recipients with CD were analyzed. RESULTS: Between August 1, 2013, and August 1, 2023, 6021 SOTs were performed. 1898 candidates (31%) were screened, and 21 (1.1%) tested positive for T. cruzi, of whom 10 were SOT recipients. All seropositive recipients were born in historically endemic areas. Median post-transplant surveillance was 13.5 (range 1-25) months. Seven patients developed Chagas disease reactivation (CDR) diagnosed by serum PCR; all were asymptomatic. Median time from transplantation to reactivation was 48 days (range 22-426). Treatment with benznidazole for 60 days cleared the parasitemia in all patients. At 2 years, 80% (8/10) had graft survival, one patient died unrelated to CDR. CONCLUSION: We report a high incidence of CDR among SOT recipients at a US transplant center serving a predominantly immigrant population, with favorable 2-year outcomes. Most reactivation events occurred early post-transplant, although a later recurrence was also observed. Intensive monitoring for CDR proved effective in detecting reactivation prior to the onset of symptoms.