More Heart Transplant Information
Why do I need a heart transplant?
References:
M. Yeatman, J.A. Smith, J.J. Dunning, S.R. Large and J. Wallwork. Cardiovascular Surgery vol 3, No 1, pp. 1-14. 1995.
Baily and Love's Short Practice of Surgery 22nd edition, edited by Charles V. Mann, R.C.G. Russell and Norman S. Williams.
Candidates for heart transplantation should have terminal heart failure, and a life expectancy of less than 12 months.
Sometimes the heart is irreversibly damaged by long-lasting heart disease or viral infection. In general, indications for heart transplantation are:
- Cardiomyopathy (acute or chronic disease of the heart muscle)
- Coronary artery disease
- Valvuler heart disease
- Re-transplantation
- Complex forms of congenital heart defects
Can anybody go through heart transplantation?
No. The criteria for recipient selection according to Papworth Hospital in Cambridge is as following:
- End-stage heart disease with life expectancy limited to 6-12 months.
- Age of less than 55 years for coronary arteries disease; less than 60 years for cardiomyopathy
- Absence of irreversible hepatic or renal failure
- Absence of active infection
- Absence of recent pulmonary infection
- Psychosocial stability
- There is no lower age limit to heart transplantation
When can't you do a heart transplant?
There are absolute and relative contraindications to heart transplantation.
- Absolute contraindications:
- active infection
- untreated malignancy
- coexisting systemic illness likely to limit survival
- severe and irreversible major organ dysfunction
- fixed elevated pulmonary vascular resistance
- Relative contraindications:
- advanced age
- recent or unresolved pulmonary infection
- active peptic ulceration
- marked peripheral or cerebrovascular disease
- mental illness
How long can I expect to live after heart transplantation?
The longest survival after heart transplantation is 24 years. The survival rate has improved dramatically during the last 10 years.
Heart transplants performed with 1, 5, and 10 year survival figures are now approaching 90%, 70%, and 50%, respectively.
What are the criteria in donor selection?
Donor selection is critically important if early postoperative problems are to be avoided.
Potential donors will be certified as brain dead if two separate brain stem function tests show no activity. Most donors have had head injuries or an intra cerebral bleeding, gunshot wound, brain tumour, or liver failure.
Ideal criteria for the donor include the following:
- age (<45 years for male, <50 years for females)
- weight (within 25 per cent of the recipient's weight)
- ABO compatibility
- no evidence of heart injury (normal ECG, normal chest X-ray)
- no evidence of active infection (HIV, hepatitis B, or bacterial)
- no malignancy apart from brain tumours.
What are the most common complications expected after heart transplantation?
There are many complications associated with heart surgery in general, but the most important complications in heart transplantation are divided into two groups:
- Early complications:
- donor organ dysfunction
- acute rejection
- renal failure
- arrhythmia (abnormal heart beat)
- bleeding
- infection
- Late complications:
- infection
- accelerated coronary athrosclerosis (coronary disease)
- chronic rejection
- hypertension (high blood pressure)
- malignancy (cancer)
What are the causes of donor heart dysfunction?
Ventricular dysfunction is often present as a result of the adverse effects of brain death on the heart; and the ischemic period during storage and transplant.
Right ventricular failure may occur because the unprepared right ventricle of the donor has to perform work against the recipient's pulmonary vascular resistance which may be elevated. Lack of reflex sympathetic enervation may diminish the heart ability to compensate for any reduction in function.
What are the causes of renal failure after heart transplantation?
Renal failure usually is caused by:
- effects of Cardiopulmonary bypass "CPB", which is a technique by which the pumping action of the heart and the gas exchange action of the lung, are replaced temporarily by a mechanical device during the heart operation.
- secondary to chronic heart failure before heart transplantation.
- nephrotoxic agents, particularly Cyclosporin drug.
Why do some patients suffer from skin cancer after transplantation?
Malignancy may be developed due to chronic use of immunosuppression drugs and rarely from receiving transmitted malignant cells with the donor organ.
The malignancies are Lymphoproliferative of the Epstein-Barr virus type or B-Cell hyperplasias.
Cancers are an unfortunate consequence of chronic immunosuppression. In general, transplant recipients have a threefold increase in the incidence in various cancers when compared with age-matched controls. Some specific cancers are more than 100 times more frequent in immunosuppressed patients than in the general population.
For all tumours, the average time of appearance of the cancer after transplantation is 58 months. The most common tumours among transplant patients are those of the skin and lips, non-Hodgkin lymphomas, Kaposi sarcomas, and uterine, cervical, vulval, and perineal cancers.
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