What Is a Heart Transplant?
A heart transplant is surgery to remove a person’s diseased heart and replace it with a healthy heart from a deceased donor. Most heart transplants are done on patients who have end-stage heart failure.
Heart failure is a condition in which the heart is damaged or weak. As a result, it can’t pump enough blood to meet the body’s needs. “End-stage” means the condition is so severe that all treatments, other than a heart transplant, have failed.
Heart transplants are done as a life-saving measure for end-stage heart failure.
Because donor hearts are in short supply, patients who need heart transplants go through a careful selection process. They must be sick enough to need a new heart, yet healthy enough to receive it.
Survival rates for people receiving heart transplants have improved, especially in the first year after the transplant.
About 88 percent of patients survive the first year after transplant surgery, and 75 percent survive for 5 years. The 10-year survival rate is about 56 percent.
After the surgery, most heart transplant patients can return to their normal levels of activity. However, less than 30 percent return to work for many different reasons.
The Heart Transplant Process
The heart transplant process starts when doctors refer a patient who has end-stage heart failure to a heart transplant center.
Staff members at the center assess whether the patient is eligible for the surgery. If the patient is eligible, he or she is placed on a waiting list for a donor heart.
Heart transplant surgery is done in a hospital when a suitable donor heart is found. After the transplant, the patient is started on a lifelong health care plan. The plan involves multiple medicines and frequent medical checkups.
What To Expect During a Heart Transplant
Just before heart transplant surgery, the patient will get general anesthesia (AN-es-THE-ze-ah). The term “anesthesia” refers to a loss of feeling and awareness. General anesthesia temporarily puts you to sleep.
Surgeons use open-heart surgery to do heart transplants. The surgeon will make a large incision (cut) in the patient’s chest to open the rib cage and operate on the heart.
A heart-lung bypass machine is hooked up to the heart’s arteries and veins. The machine pumps blood through the patient’s lungs and body during the surgery.
The surgeon removes the patient’s diseased heart and sews the healthy donor heart into place. The patient’s aorta and pulmonary arteries are not replaced as part of the surgery.
Heart transplant surgery usually takes about 4 hours. Patients often spend the first days after surgery in the intensive care unit of the hospital.
What To Expect After a Heart TransplantStaying in the Hospital
The amount of time a heart transplant recipient spends in the hospital varies. Recovery often involves 1 to 2 weeks in the hospital and 3 months of monitoring by the transplant team at the heart transplant center.
Monitoring may include frequent blood tests, lung function tests, EKGs (electrocardiograms), echocardiograms, and biopsies of the heart tissue.
A heart biopsy is a standard test that can show whether your body is rejecting the new heart. This test is often done in the weeks after a transplant.
During a heart biopsy, a tiny grabbing device is inserted into a vein in the neck or groin (upper thigh). The device is threaded through the vein to the right atrium of the new heart to take a small tissue sample. The tissue sample is checked for signs of rejection.
While in the hospital, your health care team may suggest that you start a cardiac rehabilitation (rehab) program. Cardiac rehab is a medically supervised program that helps improve the health and well-being of people who have heart problems.
Cardiac rehab includes counseling, education, and exercise training to help you recover. Rehab may start with a member of the rehab team helping you sit up in a chair or take a few steps. Over time, you’ll increase your activity level.
Watching for Signs of Rejection
Your body will regard your new heart as a foreign object. You’ll need medicine to prevent your immune system from attacking the heart.
You and the transplant team will work together to protect the new heart. You’ll watch for signs and symptoms that your body is rejecting the organ. These signs and symptoms include:
- Shortness of breath
- Fatigue (tiredness)
- Weight gain (retaining fluid in the body)
- Reduced amounts of urine (problems in the kidneys can cause this sign)
You and the team also will work together to manage the transplant medicines and their side effects, prevent infections, and continue treatment of ongoing medical conditions.
Your doctors may ask you to check your temperature, blood pressure, and pulse when you go home.
You’ll need to take medicine to suppress your immune system so that it doesn’t reject the new heart. These medicines are called immunosuppressants.
Immunosuppressants are a combination of medicines that are tailored to your situation. Often, they include cyclosporine, tacrolimus, MMF (mycophenolate mofetil), and steroids (such as prednisone).
Your doctors may need to change or adjust your transplant medicines if they aren’t working well or if you have too many side effects.
Managing Transplant Medicines and Their Side Effects
You’ll have to manage multiple medicines after having a heart transplant. It’s helpful to set up a routine for taking medicines at the same time each day and for refilling prescriptions. It’s crucial to never run out of medicine. Always using the same pharmacy may help.
Keep a list of all your medicines with you at all times in case of an accident. When traveling, keep extra doses of medicine with you (not packed in your luggage). Bring your medicines with you to all doctor visits.
Side effects from medicines can be serious. Side effects include risk of infection, diabetes, osteoporosis (thinning of the bones), high blood pressure, kidney disease, and cancer—especially lymphoma and skin cancer.
Discuss any side effects of the medicines with your transplant team. Your doctors may change or adjust your medicines if you’re having problems. Make sure your doctors know all of the medicines you’re taking.