Home | The Basics | After the Transplant | Heart

After the Transplant | Heart

The steady improvement in success rates of heart transplantation means that there are a large number of patients with long-functioning heart grafts.

Advances in medicine, including improvements in surgery and greater understanding in how to use anti-rejection drugs safely and effectively, have contributed to the success of liver transplantation.

There are many types of medications that are used to prevent rejection and there are different formulations of same anti-rejection drug.

Your transplant team will adjust the dose depending upon your risk of rejection, your weight, and other medications that you might be taking.

TYPES OF REJECTION

A rejection episode can occur even with anti-rejection drugs especially during the first few months after surgery. The word "rejection" can be frightening. However, rejection does not mean that you will lose your new organ. Knowing what rejection is and how it can be prevented or reversed will help reduce your fears.

Three types of rejection can occur after receiving an organ transplant:

• Hyperacute rejection occurs as soon as the donated organ is transplanted. This rarely occurs because transplant doctors make sure to match blood types and check if you have antibodies against the donated organ
• Acute rejection occurs at least a few days after the transplant surgery when the body has had time to identify a foreign invader.
• Chronic rejection is a very gradual type of graft injury that can occur over months or even years.

DETECTING REJECTION

A rejection episode can usually be reversed if it is caught early. The transplant team can often detect the first signs of rejection. That is why it is important to keep all appointments with your transplant team.

You should also recognize the signs and symptoms of rejection. Contact your transplant team immediately if you think you might be having a rejection episode. Symptoms of rejection of a heart graft are listed below:

Heart

Fever Shortness of breath Flu-like symptoms such as chills, nausea, vomiting, diarrhea, tiredness, headache, dizziness, body aches and pains Difficuly sleeping on your back Abnormal or irregular heartbeat Weight gain or swelling Decrease in blood pressure

The following medical tests can be used to detect rejection of a transplanted heart.

Heart	Biopsy of the right ventricle (endomyocardial biopsy) is used to check for rejection or infection	Biopsy may indicate rejection
	Echocardiogram takes a video image of the walls of the heart and the valves	Echocardiogram indicates whether the heart is pumping efficiently or whether the valves are leaking
	Cardiac catheterization measures the pressure in the heart and may be performed with or without a coronary angiogram	Cardiac catheterization shows any blockage of coronary vessels and overall functioning of the heart

IMPAIRED FUNCTION AND LOSS OF THE TRANSPLANT

In addition to rejection, there are other reasons why a transplanted organ may not function as well as it should. If your heart is not working well but you are not experiencing rejection, your doctor will be able to explain what is happening and provide the appropriate treatment.

The long-term function of the transplanted heart is related primarily to the integrity of the organ at the time of transplantation and to rejection. Other factors not related to the immune system, such as hypertension, lipid abnormalities, diabetes, and infection, also take a toll. A complicated interplay between immune and non-immune factors can lead to a type of blood vessel disease (atherosclerosis) known as allograft arteriopathy or vasculopathy.

References
Ramakrishna. Ann Card Anaesth. 2009;12:155-65
Young. Circulation. 1999;100:458-460