Heart Transplantation General Information
Evaluation for Heart Transplantation
The main purpose of the evaluation is to see if a patient may benefit from receiving a heart transplant. If it is determined that a heart transplant may be the best option, then it is necessary to see if a patient is physically able to undergo heart surgery, will recover well afterwards, be capable of assuming responsibilities in caring for oneself, and be willing to maintain a healthy lifestyle after heart transplant. As part of the evaluation process, patients undergo testing and visit with other physicians and healthcare providers.
Heart Transplantation Surgery
Heart transplantation means removing a patient's diseased or sick heart and replacing it with a healthy donor heart. More than 73,000 patients have had this surgery worldwide since 1967. Although removing the diseased heart and sewing in the donor heart can be done in less than one hour, patients are in the operating room for approximately four to six hours. Life expectancy after heart transplantation has improved dramatically over the years. While patients with advanced heart failure have lives that are severely shortened by their heart disease, patients who undergo heart transplantation may have as much as a 95% 1-year survival and 70% 10-year survival with excellent quality of life.
Complications of Heart Transplantation
Rejection and infection are common after heart transplantation. Acute rejection is a very common type of rejection. Patients can experience at least one acute rejection episode in the first year after surgery. Understanding the process of acute rejection involves understanding the immune system. The immune system includes white blood cells in the body that recognize what is part of the body and what is not. These cells protect the body from foreign invaders. When the donor heart is transplanted into the patient, the white blood cells recognize that the donor heart is foreign and will attempt to attack and destroy it. That is called acute rejection. Patients take anti-rejection medication for the rest of their lives to help prevent acute rejection, and they take additional medication to treat acute rejection.
Most of the time, patients do not have any symptoms to let them know that they are experiencing an episode of acute rejection. Therefore, it is necessary to monitor whether a patient is having acute rejection through heart biopsies. Heart biopsies are routinely performed (as an outpatient procedure) in a cardiac catheterization lab. The specific treatment of rejection depends on the biopsy results.
Patients may also experience chronic rejection (also called vasculopathy or arteriopathy) after a heart transplant. Chronic rejection is fairly common and usually occurs more than one year after surgery. Chronic rejection involves the coronary arteries of the donor heart. Chronic rejection causes the coronary artery vessel walls to become thicker, and therefore, blood flow through the narrow coronary arteries decreases. Although most patients do not experience chest pain (angina) with chronic rejection, it is possible. Being on a low fat diet, exercising, and taking anti-rejection medicines, aspirin, and other medicines may help reduce the risk of developing severe chronic rejection. Chronic rejection is monitored with cardiac catheterization testing.
Heart transplant patients are at an increased risk for infection because of the anti-rejection medicines they are taking. Anti-rejection medicines decrease the response of the immune system's ability to fight an infection. Therefore, patients learn about symptoms of an infection so that they can notify their doctor early and receive appropriate treatment.
Medications After Heart Transplantation
The most important medications that patients take after heart transplantation are the anti-rejection medications. Patients typically take either Prograf® or Neoral®, and Cellcept® and prednisone. In addition, for a few months after heart transplantation, patients take medications to reduce the risk of infection.
Recovery and Discharge Home
Although the length of stay in the hospital following a heart transplant depends on each individual patient's recovery, most patients are in the hospital for 1 1/2 -2 weeks after surgery. Patients learn about their medications, diet, activities, exercise plan and follow-up care before discharge from the hospital. After discharge, patients return to see their cardiologist for care that focuses on managing side effects of medications, preventing rejection and infection, and promoting a healthy lifestyle. When patients go home, they return to a life that is free from the symptoms of heart failure that they had before the heart transplant. They are able to return to a more normal lifestyle and again become involved in activities that they could not do when they had advanced heart failure. Many patients return to work, while others choose to retire.
Heart transplantation contributes to a longer, healthier life, but requires dedication, attention to detail, and a team effort that involves the patient, the patient's family and friends, and health care providers.
For more information regarding heart transplant or to obtain a consultation, please contact the Bluhm Cardiovascular Institute at 1-866-662-8467 or request a first time appointment online.
For information regarding other organ transplantation opportunities at Northwestern Memorial Hospital, visit the Kovler Organ Transplantation Center.