What Are the Risks of a Heart Transplant?
Although heart transplant surgery is a life-saving
measure, it has many risks. Careful monitoring, treatment, and regular medical
care can prevent or help manage some of these risks.
Risks of heart transplant include:
- Failure of the donor heart
- Complications from medicines
- Infection
- Cancer
- Problems that arise from not following lifelong
health care plans
Failure of the Donor Heart
Over time the new heart may fail due to the same
reasons that caused the original heart to fail. Failure of the donor heart also
can occur if the body rejects the donor heart or if blood vessel disease
develops in the new heart and causes it to fail. This blood vessel disease is
called cardiac allograft vasculopathy (CAV).
Patients who receive a heart transplant that fails
can be considered for another transplant (called a retransplant).
Primary Graft Dysfunction
The most frequent cause of death in the first 30
days after transplant is when the new donor heart fails and isn't able to
function. This is called primary graft dysfunction. Factors such as shock or
trauma to the donor heart or narrowed blood vessels in the recipient's lungs
can cause primary graft dysfunction. Medicines (for example, inhaled nitric
oxide and intravenous nitrates) may be used to treat this condition.
Rejection of the Donor Heart
Rejection is one of the leading causes of death in
the first year after transplant. The recipient's immune system sees the new
heart as a "foreign body" and attempts to destroy or reject it. During the
first year, 25 percent of patients have signs of a possible rejection at least
once. Half of all possible rejections happen in the first 6 weeks after
surgery, and most happen within 6 months of surgery.
Cardiac Allograft Vasculopathy
CAV is a chronic (ongoing) disease in which the
walls of the new heart's coronary arteries become thick, hard, and lose their
elasticity. CAV can destroy the circulation of blood in the donor heart and
cause serious damage.
CAV is a leading cause of donor heart failure and
death in the years following transplant surgery. It can cause
heart attack,
heart
failure, dangerous
arrhythmias, and
sudden cardiac arrest.
Complications From Medicines
Taking daily medicines that stop the immune system
from attacking the new heart is absolutely critical, even though the medicine
combinations have serious side effects.
Cyclosporine and other medicines can cause kidney
damage. Kidney damage affects more than 25 percent of patients in the first
year after transplant. Five percent of transplant patients will develop
end-stage kidney disease in 7 years.
Infection
When the immune system—the body's defense
system—is suppressed, the patient is at increased risk for infection.
Infection is a major cause of hospital admission for heart transplant patients
and a leading cause of death in the first year after transplant.
Cancer
Suppressing the immune system leaves patients at
risk for cancers and malignancies. Malignancies are a major cause of late death
in heart transplant patients—nearly 25 percent of heart transplant deaths
3 years after transplant.
The most common malignancies are tumors of the skin
and lips (patients at highest risk are older, male, and fair-skinned) and
malignancies in the lymph system such as non-Hodgkins lymphoma.
Other Complications
High
blood pressure develops in more than 70 percent of heart transplant
patients in the first year after transplant and in nearly 95 percent of
patients in 5 years.
High levels of cholesterol and triglycerides in the
blood develop in more than 50 percent of heart transplant patients in the
first year after transplant and in 84 percent of patients in 5 years.
Osteoporosis can develop or worsen in heart
transplant patients. This is a condition in which bones gradually become
thinner and weaker.
Complications From Not Following Lifelong Health
Care Plans
Not following a lifelong treatment plan increases
the risk of all heart transplant complications. Heart transplant recipients are
asked to closely follow their doctors' instructions and monitor their own
health status throughout their lives.
Lifelong health care includes taking multiple
medicines on a strict schedule, watching for signs and symptoms of
complications, keeping all medical appointments, and stopping unhealthy
behaviors such as smoking. |