Parasitic diseases in heart transplantation: challenges of Toxoplasmosis and Chagas Disease

Parasitic diseases have always caused a significant burden in endemic countries. However, due to globalization and immigration, more cases are emerging in non-endemic regions, leading to a growing incidence in solid organ transplantation. These immunocompromised patients, such diseases, have the potential to reactivate and cause severe disease and graft damage, often leading to death. Two specific parasites play a special role in the heart transplant scenario: <i>Trypanosoma cruzi</i>, responsible for Chagas disease, and T<i>oxoplasma gondii</i>, for Toxoplasmosis. In endemic countries, Chagas disease is not only one of the main indications for a heart transplant, but also responsible for several episodes of reactivation after transplantation, requiring careful surveillance for preemptive treatment. <i>T. gondii</i> has the potential to reactivate in immunocompromised hosts, leading to myocarditis and/or disseminated disease, often fatal. Prophylaxis is safe and effective to prevent reactivation. This review aims to summarize the most important aspects of Chagas disease and Toxoplasmosis in the heart transplant setting, with emphasis on pre-transplant screening, prophylaxis, and monitoring.