Heart Transplant

Potential Complications

Complications can occur after any surgery, but special complications are associated with transplantation. Your medical team has years of experience in recognizing complications and we are aware of most things that can happen. We know how to prevent complications and how to treat them if they occur. Remember that your role in monitoring your health, following a healthy lifestyle and taking your medication is critical. Some potential complications after transplant include organ rejection, infections, graft coronary artery disease, high blood pressure, diabetes, and depression.

Organ Rejection

In a healthy immune system, white blood cells circulate through the body looking for foreign invaders like bacteria or viruses. If a foreign invader enters your body, perhaps through a skin cut, your immune system automatically sees it as a threat and attacks it. Unfortunately, your new heart is also foreign and your immune system treats it the same as it would a bacteria or virus. Rejection is your body's attempt to protect you by attacking a foreign protein that has entered your body.

Preventing rejection requires taking medications called immunosuppressants. Immunosuppressant medications help prevent rejection and help your body accept the new heart by weakening or suppressing the immune system.

Currently, the only way to diagnose rejection is a heart biopsy. Routine biopsies begin approximately two weeks after your transplant and then as ordered by your transplant cardiologist. The biopsies will become less frequent as time goes on as long as you are not experiencing frequent episodes of rejection.

The procedure is performed in the Cath Lab and takes about 30 minutes. A doctor will give you a local anesthetic to numb an area around your neck. A long tube (catheter) called a bioptome is passed through a small puncture in your neck then down into your heart. Sometimes the biopsy catheter will be placed though a vein in your groin if the neck veins aren’t accessible.

A type of X-ray called fluoroscopy helps the doctors guide the bioptome into your heart. Once the bioptome reaches your heart, the doctors remove five or six tiny samples of heart tissue to examine. They will look for white blood cells to determine if you are experiencing rejection. The biopsy results are usually available within 24 to 48 hours. The Transplant Coordinator will notify you of the results as soon as possible.

A non- invasive test being used on selected patients is gene Expression profiling.  This  test is a 20-gene, real-time, quantitative polymerase chain reaction (PCR) test that measures the expression of genes associated with cardiac allograft rejection in  blood  cells.  The test is useful to identify low-risk patients who can be safely managed without routine biopsy.

Grading rejection

 The pathologist, the medical Doctor who reviews the tissue slide for the diagnosis of rejection rates the presence and severity of rejection based in the International Society and Heart Lung Transplant (ISHLT) scale.

Acute Cellular Rejection (ACR)

0 = No evidence of rejection (NER)
1R=mild rejection
2R= moderate rejection
3R= Severe rejection.

Antibody-mediated rejection (AMR)

Is a type of late or chronic rejection.  It represents a continuum of humoral responses to the cardiac allograft.   AMR is diagnosed by both the biopsy and by the detection of antibodies specific to the donor in the blood.

Treating Rejection

Having an episode of rejection can be discouraging, but remember that they are common. Most rejection episodes can be reversed if detected and treated early. Treatment for rejection is determined by severity.

The treatment may include giving you high doses of intravenous steroids called Solumedrol, changing the dosages of your anti-rejection medications, or adding new medications. Severe or persistent rejections may require treatment with powerful medications and/or plasmapheresis, a procedure in which antibodies are removed from your blood.

Early treatment is critical to successfully reversing rejection. Do not try to treat your symptoms yourself.

What more information on rejection?  Go to www.transplantliving.org

Infections

The anti-rejection medications that keep your body from rejecting your new heart have the unfortunate side effect of compromising your immune system. You may  have a reduced  ability to fight off infections the way you used to. However, you can minimize infections by preventing exposure to infections, being aware of the symptoms and seeking treatment immediately. Now that you are a transplant recipient, view all infections as potentially serious.

Graft Coronary Artery Disease

Graft coronary artery disease, which causes blockages in the heart, is the leading cause of death after the first year of heart transplantation. You can help prevent this condition by taking your medication and using conventional heart-health practices. These include controlling blood pressure and weight, maintaining a low-cholesterol diet, and doing a reasonable amount of exercise. During the first 5 years after your heart transplant, you will have an annual examination of your heart's blood vessels via a catheter inserted into the blood vessels. Blockages that can be reached by catheter may be removed or compacted with a balloon or a stent.

High Blood Pressure/hypertension

If you did not have high blood pressure before your transplant, you may have it afterward due to anti-rejection medication. Fortunately, a variety of medications are available to help you control this condition.

Diabetes: Insulin Dependent  Diabetes Mellitus (IDDM)/ Non –insulin dependent DM (NIDDM)

Diabetes can also be a side effect of some of your new anti-rejection medications. Everyone's blood sugars are different and sometimes unpredictable. This is especially true for people with heart failure. The disease progression and medications used to treat the disease can cause blood sugars to run higher or lower than usual. Some people who did not have diabetes before their transplant may find that they now have high blood sugars. For those with diabetes before transplant, the condition may be harder to manage. The medications that are taken to prevent rejection may cause blood sugars to go up.

We understand that diabetes affects each person differently. Because of this, we help create treatment programs for the special needs of each person. Individuals (pre- and post- transplant) and their families are welcome to contact the Transplant Diabetes Program and utilize the classes and programs provided.

Sexual Dysfunction

Sexual concerns after heart transplantation are commonly experienced yet seldom voiced.  The sensitivity of the topic  may prevent open discussion with your health care providers and can delay referrals, changes in medications and treatment.  The best advice is to inform your provider so that appropriate evaluation and suggestions can be considered.

Erectile dysfunction ( ED)  is prevalent in male patients who have cardiovascular disease and in patient who are on  high blood pressure medication.   ED should be reported to your primary care doctor   and /or your transplant cardiologist  as soon as possible so that referrals or treatment can be done as soon as possible.

Mental Health

For more support on Mental Health and Psychiatry. Read here.

Loss and Grief

Unfortunately, some of us will experience losses (of family members, friends, other patients) as we move through the transplantation process. Here are some sites for self-help groups which may be of benefit. Please consider contacting a mental health professional if symptoms become impairing or overwhelming.

Book recommendation

Hospice has a number of helpful links:

Stanford Medicine Resources:

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