Heart Transplantation Offers Acceptable Long-Term Survival in Chagas Heart Disease

Heart transplantation, the final treatment option for end-stage Chagas heart disease, appears to deliver acceptable long-term survival in carefully selected patients, according to a systematic review and individual patient data meta-analysis published in Frontiers in Cardiovascular Medicine. The analysis pooled individual clinical data from sixteen studies covering 305 transplant recipients with Chagas heart disease, a condition that is a leading trigger of end-stage heart failure in Latin America.

The research team, led by Tuerhongjiang Tuxun and Hao Wen of the First Affiliated Hospital of Xinjiang Medical University, retrieved eligible studies up to October 4, 2025, extracted individual clinical data from each report, and applied one-stage individual patient data and Cox regression analyses. This approach, which analyses patient-level records rather than only aggregated study results, is designed to give a more detailed picture of outcomes after transplantation than has previously been available.

Large-scale individual patient data evidence on transplant immunosuppression, parasite reactivation and long-term prognosis in this population has remained scarce, the authors note.

In the observational analyses, male sex was associated with increased risks of complications, reactivation and death among the transplant recipients. The associations involving sex were descriptive patterns observed in the pooled data rather than established causal effects.

The analysis also examined immunosuppressive drug exposures. Azathioprine exposure was associated with a lower risk of parasite reactivation, while mycophenolate mofetil exposure was associated with a lower risk of death. The authors stress that these associations are subject to confounding by indication, transplantation era, monitoring strategies and switching-time bias, and therefore cannot be interpreted as causal treatment effects. Nor, they emphasise, can the findings establish that any one immunosuppressive regimen is superior to another.

Beyond the drug-specific associations, the study included an exploratory historical comparison suggesting relatively favourable long-term survival among selected Chagas heart disease transplant recipients relative to published cohorts of patients with other cardiomyopathies. The authors caution that this comparison cannot be adequately adjusted for key patient-level confounders, so it should be read as an exploratory observation rather than a definitive conclusion about relative survival.

Overall, the meta-analysis concludes that in selected patients with end-stage Chagas heart disease, heart transplantation is a feasible treatment option associated with acceptable long-term survival outcomes. The word “selected” is important: the pooled cohort reflects patients who were deemed suitable candidates for transplantation, and the findings apply to that population rather than to all patients with the disease.

The article appears in the journal’s Heart Failure and Transplantation section as an open-access systematic review article.

For clinicians managing Chagas heart disease, the study adds individual patient-level evidence to a field where aggregated data have dominated, and it highlights both the potential of transplantation and the limits of observational analyses in this setting. The authors’ own framing is measured: the associations reported here describe patterns in the data, and treatment decisions for individual patients require consideration of the biases the authors enumerate, including differences in transplantation era and monitoring strategies across the sixteen included studies.

Subject of Research: Survival and parasite reactivation risk after heart transplantation in Chagas heart disease

Article Title: Survival and reactivation risk after heart transplantation in Chagas heart disease: a systematic review and individual patient data meta-analysis

Article References: Song, Z.-H., Abudukadi, G., He, R.-D., Tulading, A., Azhati, Y., Maimaiti, M., Nuermaimaiti, M., Lv, C.-H., Wang, M.-J., Zeng, H.-C., Keranmu, G., Anvarbek Ikrom Ugli, K., Munisa, K., Tuxun, T., & Wen, H. (2026). Survival and reactivation risk after heart transplantation in Chagas heart disease: a systematic review and individual patient data meta-analysis. Frontiers in Cardiovascular Medicine, 13, Article 1950776. https://doi.org/10.3389/fcvm.2026.1950776

Image Credits: AI Generated

DOI: 10.3389/fcvm.2026.1950776

Keywords: Chagas heart disease, heart transplantation, individual patient data meta-analysis, systematic review, parasite reactivation, immunosuppression, azathioprine, mycophenolate mofetil, heart failure, Trypanosoma cruzi, survival outcomes, Latin America