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Heart Failure and Heart Transplants

What Are the Risks of a Heart Transplant?

The most common causes of death following a heart transplant are infection and rejection. Patients on drugs to prevent rejection of the new heart are at risk for developing kidney damage, high blood pressure, osteoporosis (a severe thinning of the bones, which can cause fractures), and lymphoma (a type of cancer that affects cells of the immune system).

Atherosclerosis of the heart's arteries or coronary artery disease develops in almost half the patients who receive transplants. And many of them have no symptoms, such as angina (chest pain), because they have no sensations in their new hearts.


What Is Organ Rejection?

Normally, the body's immune system protects the body from infection. This occurs when cells of the immune system move around the body, checking for anything that looks foreign or different from the body's own cells.

Rejection occurs when the body's immune cells recognize the transplanted heart as different from the rest of the body and attempt to destroy it. If left alone, the immune system would damage the cells of a new heart and eventually destroy it.

To prevent rejection, patients receive several drugs called immunosuppressants. These drugs suppress the immune system so that the new heart is not damaged. Because rejection can occur anytime after a transplant, immunosuppressive drugs are given to patients the day before their transplant and thereafter for the rest of their lives.

To avoid rejection, heart transplant recipients must strictly adhere to their immunosuppressant drug regimen. Researchers are continually working on safer, more effective, and well-tolerated immunosuppressant drugs. However, too much immunosuppression can lead to serious infections. Without an active enough immune system, a patient can easily develop severe infections. For this reason, medications are also prescribed to fight infections.

Heart transplant recipients are carefully monitored for signs of rejection. Doctors frequently take samples of small pieces of the transplanted heart to inspect under a microscope. Called a biopsy, this procedure involves advancing a thin tube called a catheter through a vein to the heart. At the end of the catheter is a bioptome, a tiny instrument used to snip off a piece of tissue. If the biopsy shows damaged cells, the dose and kind of immunosuppressive drug may be changed. Biopsies of the heart muscle are usually performed weekly for the first three to six weeks after surgery, then every three months for the first year, and then yearly thereafter.

It is vital for you to be aware of the possible signs of rejection and infection so you can report them to your doctors and be treated immediately.

Signs of organ rejection include:

  • Fever over 100.4°F (38°C)
  • "Flu-like" symptoms such as chills, aches, headaches, dizziness, nausea, and/or vomiting
  • Shortness of breath
  • New chest pain or tenderness
  • Fatigue or generally feeling "lousy"
  • Elevation in blood pressure

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