Survival and reactivation risk after heart transplantation in Chagas heart disease: a systematic review and individual patient data meta-analysis
- 1Department of Liver Transplantation & Laparoscopic Surgery, Digestive & Vascular Surgery Center, The First Affiliated Hospital of Xinjiang Medical University
- 2State Key Laboratory of Pathogenesis, Prevention, Treatment of High Incidence Diseases in Central Asia, Xinjiang Medical University
- 3Department of Hepatobiliary & Hydatid Disease, Digestive & Vascular Surgery Center, The First Affiliated Hospital of Xinjiang Medical University
Abstract
Introduction: Chagas heart disease (ChHD) is a leading trigger of end-stage heart failure in Latin America, with heart transplantation as its final treatment. Large-scale individual patient data (IPD) evidence on transplant immunosuppression, parasite reactivation and long-term prognosis remains scarce.
Methods: We conducted an IPD meta-analysis by retrieving eligible studies up to October 4, 2025, extracting individual clinical data and adopting one-stage IPD and Cox regression analyses.
Results: Sixteen studies with 305 ChHD transplant recipients were enrolled. Male sex was associated with increased risks of complications, reactivation, and death in observational analyses. Similarly, AZA exposure was associated with a lower risk of reactivation, and MMF exposure was associated with a lower risk of death. Notably, exploratory historical comparison suggests relatively favourable long-term survival among selected ChHD transplant recipients relative to published cohorts of other cardiomyopathies, though this finding cannot be adequately adjusted for key patient-level confounders.
Discussion: These associations are subject to confounding by indication, transplantation era, monitoring strategies, and switching-time bias. They therefore cannot be interpreted as causal treatment effects, nor can they establish that any one regimen is superior. In selected patients with end-stage Chagas heart disease, heart transplantation is a feasible treatment option associated with acceptable long-term survival outcomes.
Systematic Review Registration: PROSPERO [CRD420251163696].
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BibTeX
@article{song2026survival,
title = {{Survival and reactivation risk after heart transplantation in Chagas heart disease: a systematic review and individual patient data meta-analysis}},
author = {Zhi-hao Song and Guzinayi Abudukadi and Rong-Dong He and Aliya Tulading and Yilizhati Azhati and Maiwulanjiang Maimaiti and Mirizhati Nuermaimaiti and Chun-Hui Lv and Ming-Juan Wang and Hui-cheng Zeng and Guliziran Keranmu and Kurbanov Anvarbek Ikrom Ugli and Khimmatova Munisa and Tuerhongjiang Tuxun and Hao Wen},
journal = {Frontiers in Cardiovascular Medicine},
year = {2026},
month = oct,
doi = {10.3389/fcvm.2026.1950776},
url = {https://www.frontiersin.org/articles/10.3389/fcvm.2026.1950776/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Survival and reactivation risk after heart transplantation in Chagas heart disease: a systematic review and individual patient data meta-analysis
AU - Zhi-hao Song
AU - Guzinayi Abudukadi
AU - Rong-Dong He
AU - Aliya Tulading
AU - Yilizhati Azhati
AU - Maiwulanjiang Maimaiti
AU - Mirizhati Nuermaimaiti
AU - Chun-Hui Lv
AU - Ming-Juan Wang
AU - Hui-cheng Zeng
AU - Guliziran Keranmu
AU - Kurbanov Anvarbek Ikrom Ugli
AU - Khimmatova Munisa
AU - Tuerhongjiang Tuxun
AU - Hao Wen
PY - 2026
DA - 2026/10/28
JO - Frontiers in Cardiovascular Medicine
DO - 10.3389/fcvm.2026.1950776
UR - https://www.frontiersin.org/articles/10.3389/fcvm.2026.1950776/full
AB - Introduction: Chagas heart disease (ChHD) is a leading trigger of end-stage heart failure in Latin America, with heart transplantation as its final treatment. Large-scale individual patient data (IPD) evidence on transplant immunosuppression, parasite reactivation and long-term prognosis remains scarce. Methods: We conducted an IPD meta-analysis by retrieving eligible studies up to October 4, 2025, extracting individual clinical data and adopting one-stage IPD and Cox regression analyses. Results: Sixteen studies with 305 ChHD transplant recipients were enrolled. Male sex was associated with increased risks of complications, reactivation, and death in observational analyses. Similarly, AZA exposure was associated with a lower risk of reactivation, and MMF exposure was associated with a lower risk of death. Notably, exploratory historical comparison suggests relatively favourable long-term survival among selected ChHD transplant recipients relative to published cohorts of other cardiomyopathies, though this finding cannot be adequately adjusted for key patient-level confounders. Discussion: These associations are subject to confounding by indication, transplantation era, monitoring strategies, and switching-time bias. They therefore cannot be interpreted as causal treatment effects, nor can they establish that any one regimen is superior. In selected patients with end-stage Chagas heart disease, heart transplantation is a feasible treatment option associated with acceptable long-term survival outcomes. Systematic Review Registration: PROSPERO [CRD420251163696].
SN - 2297-055X
ER -