Introduction: Chagas disease (CD) affects approximately eight million people worldwide, implying that, in the endemic regions, a large number of donors/recipients are exposed to contaminated organs. Symptoms range varies from asymptomatic to severe cardiac and digestive complications. Therefore screening is vital since immunosuppression predisposes to disease activation.

Method: A retrospective uncontrolled cohort study with renal transplant recipients (RTR), performed between 2012 and 2020, with recipients with positive serology for Chagas disease (R+), donors with positive serology (D+), or both positive (D+ and R+). Patients were identified by reviewing medical records or dispensing Benznidazole used in the postoperative period. Patients were monitored for CD recurrence by parasitemia, serology, and PCR.

Results: Fifty-three deceased donor KTR were included, 36 men (67.9%), 51 caucasoid (96.2%), with a mean age of 53.9±12.4 years. The cause of renal failure was from undetermined etiology in 17 patients (32%), diabetic nephropathy in 10 patients (18.8%), and hypertension in 9 patients (16.9%). In all transplants, there was a positive serology for CD. There were 40 positive donors (75%) nine positive recipients (16%), ad in four cases, both the donor and the recipient were seropositive. All patients received post-transplant prophylaxis with benznidazole at a 100–500 mg/day dose for 4-90 days (median for 22 days). One patient presented urticaria and angioedema as an adverse event determining early benznidazole discontinuation. The most commonly used initial immunosuppressive regimen was thymoglobulin (ATG), sodium mycophenolate (MFS), and methylprednisolone in 25 patients (47.1%), and 40 patients (75.4%) received a regimen containing ATG. The maintenance immunosuppression consisted of MFS, tacrolimus, and prednisone in 51 patients (98%). The incidence of acute rejection in the first year after transplantation was 11% (six cases). No cases of Chagas disease reactivation occurred. Patient and graft survival rates were 75% and 81%, respectively, five years after grafting.

Conclusions: Chagas disease-positive serology, either in the donor, in the recipient, or both, in KTR receiving benznidazole prophylaxis, allowed more patients to be transplanted. The primary transplant outcomes were similar to those observed in KTR not exposed to Chagas disease.