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March 12, 2008

Organ Transplantation and Chagas Disease—Reply

JAMA. 2008;299(10):1134-1135. doi:10.1001/jama.299.10.1134-b

In Reply: Dr Altclas and colleagues present issues related to posttransplantation reactivation of Trypanosoma cruzi infection. We believe that our recommendations do not conflict substantially with their viewpoint.

We do not recommend routine pretransplantation chemotherapy for patients who have received treatment in the past. Our recommendation to treat patients with impending immunosuppression (from human immunodeficiency virus infection, induction for organ transplant, or other etiologies) who have not previously received antitrypanosomal therapy should be interpreted in the context of our overall BII recommendation for T cruzi–infected adults up to age 50 years without advanced heart disease. The major objective of etiologic treatment in this setting is to prevent development or progression of cardiomyopathy.