Heart transplant (cont.)
Our Heart Transplant Main Article provides a comprehensive look at the who, what, when and how of Heart Transplant
The most common causes of death following a heart transplant are infection or rejection of the heart. Patients on drugs to prevent transplant rejection are at risk for developing kidney damage, high blood pressure, osteoporosis, and lymphoma (a malignancy of the immune system). Coronary artery disease (atherosclerosis) is a problem in almost half of patients. Normally, patients with this disease experience chest pain or other symptoms of angina when their hearts are under stress. However, transplant patients may have no early pain symptoms of a blockage building up because they have no sensations in their new hearts.
To prevent rejection, patients receive immunosuppressants. Because rejection can occur anytime after a transplant, immunosuppressive drugs are given to patients the day before the transplant and thereafter for the rest of their lives. The three main drugs now being used are cyclosporine, azathioprine, and prednisone.
To monitor for signs of heart rejection, small pieces of the transplanted heart are removed for inspection under a microscope. Called a biopsy, this procedure involves advancing a thin tube called a catheter through a vein to the heart. At the end of the catheter is a bioptome, a tiny instrument used to snip off a piece of tissue. If the biopsy shows damaged cells, the dose and kind of immunosuppressive drug may be changed. Biopsies of the heart muscle are usually performed weekly for the first 3 to 6 weeks after surgery, then every 3 months for the first year, and then yearly thereafter.
The prognosis (outlook) depends on many factors including age, general health, and response to the transplant. Nearly 85% of patients return to work or other activities they like. Many patients enjoy swimming, cycling, running, or other sports. More than 70% of heart transplant patients live at least 3 years after surgery. The 10-year survival rate after heart transplantation (as of 2001) is about 45%.
Last Editorial Review: 8/28/2013
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