Heart Transplant (cont.)
How does a heart transplant patient know if he or she is rejecting the donor organ or developing an infection?
This is not an easy question to answer because many of the symptoms and signs of rejection and infection are the same. These include:
- weakness,
- fatigue,
- malaise (feeling lousy),
- fever, and
- "flu-like symptoms", such as chills, headaches, dizziness, diarrhea, nausea and/or vomiting.
The more specific symptoms and signs of infection will vary greatly depending upon the site of infection within the body.
Transplant patients who experience any of these findings need to seek medical attention immediately. The transplant physician will then do tests to determine whether the transplanted heart is functioning normally or not. If there is no evidence of rejection, a thorough search for infection will be performed so that the patient can be treated appropriately.
How is rejection of the organ diagnosed and monitored?
Currently, the gold standard for monitoring rejection is the endomyocardial
biopsy. This is a simple operation for the experienced cardiologist and can be
done as an outpatient procedure. First, a catheter is put into the
jugular vein
in the neck. From there, the catheter is advanced into the right side of the
heart (right ventricle) using an x-ray method called
fluoroscopy for guidance.
The catheter has a bioptome at its end, a set of two small cups which can be
closed to pinch off and remove small samples of
heart muscle. The tissue is
processed and placed on glass slides to be reviewed under the microscope by a
pathologist. Based on the findings, the pathologist can determine whether or not
there is rejection.
Immunosuppressive therapy is then adjusted, for example,
increased if rejection is present. Investigators have tried to develop less
invasive methods to monitor for rejection. There is a new high-tech analysis
that can be done in a sample of blood that is very promising and much easier for
the patient than the endomyocardial biopsy. This test looks at the expression of
specific genes in cells in the blood. The amount of expression of key genes
indicates whether or not rejection is occurring. Nevertheless, so far, no method
has replaced the endomyocardial biopsy.
Next: Why aren't more heart transplants done? »
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