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Cardiac Transplantation
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What is cardiac transplantation? In a heart transplant, the diseased heart is replaced with a healthy heart from a donor who has recently died. When is it used? People who have heart diseases that limit their ability to function or whose disease keeps getting worse are candidates for transplants. The most common of these diseases is heart failure caused by cardiomyopathy, a heart muscle disease. Other possible candidates for surgery are people with:
What are the steps in obtaining a transplant? If you might be a candidate for a heart transplant, you will be referred to an evaluation team at a hospital where this kind of surgery is done. The tests required may include:
Sometimes the evaluation may suggest that another kind of treatment may help, such as a change in medicines or a mechanical device to assist heart function. If a heart transplant is your best option, your name will be placed on a list of those waiting for a donor heart. People on the list are divided into two groups: those who will die if they do not get a new heart soon and those who appear to be able to survive longer. This ensures that a donor heart will go to the person who needs it most. Both regional and national lists are kept. While waiting for a heart, you will learn about the diet you need to follow and medicines you need to take after surgery. You will be given a pager so the transplant center can contact you if there is a match. There are more people who need a new heart than there are hearts that can be used. A computer matches the donated heart to the person who would benefit the most. The match is based on how compatible the tissues are and on the severity of the illness of the heart patient. How do I prepare for the procedure? Always keep a bag packed in case you are called. Follow your doctor's advice about activity and medicines. What happens during the procedure? When a matching donor heart is found, you will be notified and told to go quickly to the transplant center. The transplant team will prepare for immediate surgery. The donor heart cannot survive without fresh blood for more than 4 to 6 hours. When everything is ready, your failing heart is removed and the donor heart sewn in place. It begins beating immediately and takes the place of your diseased heart. What happens after the procedure? Once the donor heart is transplanted, your body regards it as foreign and tries to reject it. Powerful drugs called immunosuppressants are used to fight rejection. They must be taken for the rest of your life. How long you will be in the hospital depends on whether your body rejects the new heart and how severe these problems are. Most people are home within 30 days of surgery. You can usually expect full recovery within 3 to 6 months. Most people can resume normal physical activities. How is rejection diagnosed? The most accurate way to tell if your body is rejecting the new heart is to examine a small piece of heart muscle under a microscope. This is called a biopsy. The individual heart muscle cells show changes in their structure. A biopsy may be done even when there is no evidence of rejection. This is usually done soon after a transplant to try to detect rejection very early. The doctor takes a sample of the heart muscle with a bioptome. This device is a thin, flexible tube (catheter) with small cutting jaws at its tip. Local anesthesia allows it to be inserted through a neck vein without pain. The tube is then moved through the vein into your heart. The cutting jaws remove a very small piece of muscle from inside the heart and withdraw it from the body. You will not feel pain when the muscle is cut. This procedure is quite simple and causes very few problems. Your doctor may change your dose of the drugs you take to suppress your immune system, depending on the biopsy results. How is rejection treated? Almost all people who get transplants have some degree of rejection. This usually happens during the first 3 months after surgery. The drugs used to prevent rejection reduce the body's own normal immunity and may affect the body's ability to fight infections. Infections can quickly become a serious problem. Report all fevers and infections to your doctor promptly. In rare cases, a second transplant may be needed. What are the risks? There is risk with every treatment or procedure. Talk to your provider for complete information about how the risks apply to you. The main risks are rejection of the donor heart and infection. Other risks are side effects caused by immunosuppressants. The most serious side effects are high blood pressure (hypertension), high cholesterol, kidney damage, small shaking movements of the arms and legs, and a condition similar to diabetes. Most of these side effects can be managed by adjusting drug dosages or by taking other medicines. Your doctor will always be on the alert for these problems at your routine office visits. For unknown reasons, some transplanted hearts rapidly develop hardening of the arteries (atherosclerosis) in the coronary arteries. This leads to narrowing or complete blockage of the coronary arteries in the transplanted heart. Eventually, this can cause a heart attack. A number of people who have had heart transplants develop emotional problems that may require treatment. Anxiety and frequent mood shifts may be due to the stress of managing chronic illness. Some of the medicines you take may also affect mood. What are the benefits? Cardiac transplantation today is limited by the supply of donor hearts. It requires lifelong watchfulness for rejection and blockage of heart arteries. It is expensive. Despite these problems, most recipients will be able to live nearly normally. How can I help myself? Call your doctor right away if you have a fever or infection. Carefully follow your doctor's instructions and keep every scheduled visit.  Disclaimer: This content is reviewed periodically and is subject to
change as new health information becomes available. The
information provided is intended to be informative and educational and is not a
replacement for professional medical evaluation, advice, diagnosis or
treatment by a healthcare professional.
HIA File CRD3630F.HTM Release 9.0/2006. Copyright © 2006 McKesson Corporation and/or one of its subdiaries. All Rights Reserved.
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