Our Summary

Heart transplantation is the best treatment for severe heart failure. Thanks to progress in suppressing the immune system to accept the new heart, the success rates of these transplants continue to improve, even in older and higher risk patients. On average, an adult lives around 10.7 years after a heart transplant.

However, there are still risks and challenges. Early death after the transplant is usually caused by the new heart failing or other organs not working properly. Later on, risks include cancer, rejection of the new heart, infection, and blood vessel disease in the new heart.

Kidney problems are also quite common after a heart transplant, affecting up to 68% of patients within 10 years. Some of these patients will need dialysis or a kidney transplant.

One area that needs improvement is helping patients get back to normal life after the transplant. Only about a quarter of patients are able to work one year after their transplant, possibly due to depression. Future research will focus on better understanding and managing issues with the new heart not working properly and reducing complications from suppressing the immune system.

FAQs

  1. What is the median survival rate after a heart transplant?
  2. What are the most common causes of mortality after a heart transplant?
  3. What percentage of heart transplant recipients experience renal dysfunction?

Doctor’s Tip

One helpful tip a doctor might tell a patient about heart transplant is to closely follow the medication regimen prescribed for immunosuppression. These medications are crucial in preventing rejection of the transplanted heart, but they can also increase the risk of infection and other complications. It is important to take these medications as directed and to communicate any concerns or side effects to your healthcare team. Additionally, maintaining a healthy lifestyle with regular exercise, a balanced diet, and avoiding smoking and excessive alcohol consumption can help improve long-term outcomes after heart transplantation.

Suitable For

Patients who are typically recommended for heart transplant are those who have advanced heart failure that is not responsive to other medical or surgical treatments. These patients may have severe symptoms such as shortness of breath, fatigue, and fluid retention, and may have a poor prognosis without a transplant. They may also have other medical conditions that make them good candidates for a heart transplant, such as being relatively young and otherwise healthy.

In addition, patients who have experienced complications from previous heart surgeries or treatments, such as ventricular assist devices, may also be considered for heart transplant. Patients who have a high risk of sudden cardiac death or who have a poor quality of life due to their heart failure may also be recommended for a heart transplant.

Overall, the decision to recommend a heart transplant is made on a case-by-case basis, taking into account the patient’s medical history, current health status, and likelihood of benefiting from a transplant.

Timeline

Before heart transplant:

  1. Patient is diagnosed with advanced heart failure and traditional treatments have been unsuccessful.
  2. Patient undergoes extensive medical evaluation to determine eligibility for heart transplant.
  3. Patient is placed on the heart transplant waiting list and waits for a suitable donor match.
  4. Patient’s condition may deteriorate while waiting for a donor heart, leading to hospitalizations and worsening symptoms.
  5. Patient receives notification of a donor heart match and prepares for the transplant surgery.

After heart transplant:

  1. Patient undergoes heart transplant surgery, which typically lasts several hours.
  2. Patient is closely monitored in the intensive care unit (ICU) for several days following the surgery.
  3. Patient begins the recovery process, which includes physical therapy, medication management, and regular follow-up appointments.
  4. Patient may experience complications such as organ rejection, infection, or cardiac allograft vasculopathy in the months and years following the transplant.
  5. Patient’s overall health and quality of life improve as the new heart functions effectively.
  6. Patient continues to take immunosuppressant medications to prevent rejection of the donor heart.
  7. Patient may experience long-term complications such as chronic renal dysfunction, depression, and reduced functional outcomes.
  8. Patient’s survival and quality of life are closely monitored by a multidisciplinary team of healthcare providers.

What to Ask Your Doctor

  1. What is the success rate of heart transplant surgery?
  2. What are the potential risks and complications associated with heart transplant surgery?
  3. How long is the recovery process after a heart transplant?
  4. What medications will I need to take post-transplant and what are the potential side effects?
  5. How often will I need to follow up with my transplant team after surgery?
  6. How will my lifestyle need to change after a heart transplant?
  7. What are the signs of rejection and how will they be monitored?
  8. Are there any restrictions on physical activity after a heart transplant?
  9. How long can I expect the transplanted heart to last?
  10. What are the long-term implications of having a heart transplant?

Reference

Authors: McCartney SL, Patel C, Del Rio JM. Journal: Best Pract Res Clin Anaesthesiol. 2017 Jun;31(2):237-248. doi: 10.1016/j.bpa.2017.06.003. Epub 2017 Jun 23. PMID: 29110796