HEART TRANSPLANTATION RISKS RESULTS
Category: Cardiovascular Surgery
Abstract : The most common and dangerous complications of heart transplant surgery are
organ rejection and infection. Immunosuppressive drugs are given to prevent
rejection of the heart. Most heart transplant patients have a rejection episode
soon after transplantation. Rapid diagnosis ensures quick treatment, and when
the response is quick, drug therapy is most successful. Rejection is treated
wit
The most common and dangerous complications of heart transplant surgery are
organ rejection and infection. Immunosuppressive drugs are given to prevent
rejection of the heart. Most heart transplant patients have a rejection episode
soon after transplantation. Rapid diagnosis ensures quick treatment, and when
the response is quick, drug therapy is most successful.
Rejection is treated
with combinations of immunosuppressive drugs given in higher doses than
immunosuppressive maintenance. Most of these rejection situations are
successfully treated.
Infection can result from the surgery, but most infectionsare a side effect
of the immunosuppressive drugs. Immunosuppressive drugs keep the immune system
from attacking the foreign cells of the donor heart. However, the suppressed
immune cells are then unable to adequately fight bacteria, viruses, and other
microorganisms. Microorganisms that normally do not affect persons with healthy
immune systems can cause dangerous infections in transplant patients taking
immunosuppressive drugs. Patients are given antibiotics during surgery to
prevent bacterial infection. They may also be given an antiviral drug to prevent
virus infections. Patients who develop infections may need to have their
immunosuppressive drugs changed or the dose adjusted. Infections are treated
with antibiotics or other drugs, depending on the type of infection.
Other complications that can happen immediately after surgery are:
•
bleeding
• pressure on the heart caused by fluid in the space surrounding the
heart (pericardial tamponade)
• irregular heart beats
• reduced cardiac
output
• increased amount of blood in the circulatory system
• decreased
amount of blood in the circulatory system
About half of all heart transplant patients develop coronary artery disease
one to five years after the transplant. The coronary arteries supply blood to
the heart. Patients with this problem develop chest pains called angina. Other
names for this complication are coronary allograft vascular disease and chronic
rejection.
Normal results
Heart transplantation is an appropriate treatment for many
patients with end-stage heart failure. The outcomes of heart transplantation
depend on the patients age, health, and other factors. According to a year 2000
data from the Registry of the International Society for Heart and Lung
Transplantation (ISHLT), 81% of transplant recipients survive one year. During
the first year, infection and acute rejection are the leading causes of death. A
constant 4% decrease occurs yearly after the first year as the incidence of
coronary allograft vascular disease increases.
Pediatric patients less than one year of age are least likely to reject the
donor heart, but 30% of older pediatric patients succumb to transplant
rejection. After transplant, most patients regain normal heart function, meaning
the heart pumps a normal amount of blood. A transplanted heart usually beats
slightly faster than normal because the heart nerves are cut during surgery. The
new heart also does not increase its rate as quickly during exercise. Even so,
most patients feel much better and their capacity for exercise is dramatically
improved from before they received the new heart. About 90% of survivors at five
years will have no symptoms of heart failure. Patients return to work and other
daily activities. Many are able to participate in sports.
Alternatives
End-stage heart disease is associated with a high mortality
rate even with associated medical treatment. With as many as 30,000 patients
awaiting transplantation according to the ISHLT database, and only 2,196
transplants performed in 2000, viable alternatives are necessary. Additionally,
500,000 patients in the United States are diagnosed with cardiac failure, adding
to the almost 4.5 million already affected. Data from the REMATCH trial,
published in 2001, demonstrated ventricular assist to be a viable alternative
for patients not eligible for cardiac transplant compared to medical therapy
alone. After one year, quality of life was improved in patients who received
ventricular assist device compared to medical therapy alone. Additionally,
biventricular pacing and myocardial resection for ventricular restoration show
promising results. Adding destination therapies such as the AbioCor total
artificial heart and the Thoratec Heart- Mate VE may provide other alternatives
for the transplant candidate.
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