A heart transplant involves surgically removing a heart from a deceased donor and implanting it into a recipient whose heart has failed. Heart disease is a major health problem in the United States, affecting millions and being a leading cause of death. Candidates for heart transplants include those with severe heart failure that does not improve with treatment. After evaluation, recipients undergo the transplant and face risks of complications like rejection by the immune system, infections, high blood pressure, and other issues requiring lifelong medication and monitoring.

1. Cardiac TransplantCardiac Transplant
ComplicationsComplications

2. IntroductionIntroduction
 What is a Heart Transplant?What is a Heart Transplant?
 A heart transplant is an operation in which aA heart transplant is an operation in which a
heart from someone who has died is placedheart from someone who has died is placed
into another person whose own heart has failedinto another person whose own heart has failed
due to severe heart disease.due to severe heart disease.
 Over the last decade, cardiac transplantationOver the last decade, cardiac transplantation
has evolved into the treatment of choice forhas evolved into the treatment of choice for
many people with severe heart failure (HF) whomany people with severe heart failure (HF) who
continue to have symptoms despite maximumcontinue to have symptoms despite maximum
medical therapy.medical therapy.

3. How Common is Serious HeartHow Common is Serious Heart
Disease?Disease?
 It affects approximately 60 millionIt affects approximately 60 million
people in the United States.people in the United States.
 It is the leading killer of all Americans.It is the leading killer of all Americans.
 Nearly 750,000 Americans die eachNearly 750,000 Americans die each
year from heart disease.year from heart disease.
 It is the leading cause of death inIt is the leading cause of death in
American women, claiming the livesAmerican women, claiming the lives
of nearly 500,000 women each year.of nearly 500,000 women each year.

4. Candidates for HeartCandidates for Heart
Transplants May Include:Transplants May Include:
 Adults with heart failure that does notAdults with heart failure that does not
respond to other available treatmentrespond to other available treatment
 Infants and children with congenital heartInfants and children with congenital heart
defects or a disease affecting the heartdefects or a disease affecting the heart
muscle, called dilated cardiomyopathymuscle, called dilated cardiomyopathy
 People with other types of acute or chronicPeople with other types of acute or chronic
heart problems andheart problems and
 People who have advanced (end stage)People who have advanced (end stage)
heart failure, but are otherwise healthy.heart failure, but are otherwise healthy.
 The majority (52 percent) of candidates areThe majority (52 percent) of candidates are
aged 50 to 64; 22 percent are aged 35 toaged 50 to 64; 22 percent are aged 35 to
49.49.

5. The pt Evaluation for a HeartThe pt Evaluation for a Heart
Transplant consist of:Transplant consist of:
 Meeting with a transplant surgeonMeeting with a transplant surgeon
and with a transplant coordinator atand with a transplant coordinator at
the heart transplant centerthe heart transplant center
 Medical history reviewMedical history review
 Physical examination by thePhysical examination by the
transplant doctortransplant doctor

6. Pt evaluation cont:Pt evaluation cont:
 May also receiveMay also receive
 Blood tests, including blood and tissue typingBlood tests, including blood and tissue typing
 Evaluation of your heart function, includingEvaluation of your heart function, including
echocardiogram and heart catheterizationechocardiogram and heart catheterization
 Pulmonary function testsPulmonary function tests
 Evaluation of your kidneys, including a 24-hrEvaluation of your kidneys, including a 24-hr
urine testurine test
 Social and psychological evaluationSocial and psychological evaluation
 Eye and dental examsEye and dental exams
 The wait for a heart transplant may rangeThe wait for a heart transplant may range
from 50 days to two years. But thefrom 50 days to two years. But the
average time a candidate spends on theaverage time a candidate spends on the
waiting list is about 266 days.waiting list is about 266 days.

7. Complications that May OccurComplications that May Occur
with Heart Transplants:with Heart Transplants:
 RejectionRejection
 The body will attack anything that is notThe body will attack anything that is not
its own.its own.
 Rejection usually occurs in the first sixRejection usually occurs in the first six
weeks after surgery.weeks after surgery.
 Most common S/S of rejection mayMost common S/S of rejection may
include:include:
 Shortness of breathShortness of breath
 TirednessTiredness
 FeverFever

8. Complications cont:Complications cont:
 InfectionInfection
 Immunosuppressant meds. can increase your chances ofImmunosuppressant meds. can increase your chances of
certain types of infections.certain types of infections.
 Lung InfectionsLung Infections
 Lungs are the most common site for infections to developLungs are the most common site for infections to develop
after any transplant.after any transplant.
 Daily chest x-rays will be taken for the first few days afterDaily chest x-rays will be taken for the first few days after
the surgery and from time to time when the pt comes tothe surgery and from time to time when the pt comes to
clinic.clinic.
 Most Common Signs of Lung Infection:Most Common Signs of Lung Infection:
 Harsh cough in which pts are bringing up mucusHarsh cough in which pts are bringing up mucus
 Shortness of breathShortness of breath
 FeverFever

9. Complications cont:Complications cont:
 Opportunistic InfectionsOpportunistic Infections
 Caused by the normal bacteria, viruses, and fungi thatCaused by the normal bacteria, viruses, and fungi that
float around in the air or normally live on our skinfloat around in the air or normally live on our skin
 Some of the common opportunistic infections areSome of the common opportunistic infections are
 Pneumocystis carinii pneumonia (PCP)Pneumocystis carinii pneumonia (PCP)
 Cytomegalovirus pneumonia (CMV)Cytomegalovirus pneumonia (CMV)
 Herpes simplex virus (cold sores)Herpes simplex virus (cold sores)
 Herpes zoster (virus that causes shingles)Herpes zoster (virus that causes shingles)
 Mumps, Measles or Chicken poxMumps, Measles or Chicken pox
 It is extremely dangerous to transplant pts if they haven’tIt is extremely dangerous to transplant pts if they haven’t
had these diseases and become exposed to any one ofhad these diseases and become exposed to any one of
them. Special immunizations may be required within 72them. Special immunizations may be required within 72
hrs. after exposurehrs. after exposure
 Important sign of these infections is a fever of 100F orImportant sign of these infections is a fever of 100F or
higher for more than 4 hrs or sudden high fever of 101Fhigher for more than 4 hrs or sudden high fever of 101F
or higher.or higher.

10. Complications cont:Complications cont:
 High Blood PressureHigh Blood Pressure
 High BP can damage the kidneys and causeHigh BP can damage the kidneys and cause
strokes and heart attacks.strokes and heart attacks.
 Diabetes MellitusDiabetes Mellitus
 Even if the pt never had diabetes, theEven if the pt never had diabetes, the
antirejection meds used to suppress theantirejection meds used to suppress the
immune system can cause diabetes. Can alsoimmune system can cause diabetes. Can also
make the control of the pt blood sugar moremake the control of the pt blood sugar more
difficult.difficult.
 High CholesterolHigh Cholesterol
 Pt antirejection meds can cause the bloodPt antirejection meds can cause the blood
cholesterol to go up.cholesterol to go up.

11. Complications cont:Complications cont:
 Reappearance of Heart DiseaseReappearance of Heart Disease
 CancerCancer
 Antirejection medications may increase the risk.Antirejection medications may increase the risk.
 OsteoporosisOsteoporosis
 Thinning of bones due to being ill, poor diet, poor activity, orThinning of bones due to being ill, poor diet, poor activity, or
prednisone (anti-inflammatory agent) and other antirejectionprednisone (anti-inflammatory agent) and other antirejection
medicines.medicines.
 CataractsCataracts
 Kidney DiseaseKidney Disease
 The main meds and many of the anti inflammatory meds canThe main meds and many of the anti inflammatory meds can
hurt the kidneys.hurt the kidneys.
 If pt is older or if their kidneys have already been injured byIf pt is older or if their kidneys have already been injured by
illness or medications, permanent kidney damage may occur.illness or medications, permanent kidney damage may occur.
This can cause:This can cause:
 Edema in the lower extremitiesEdema in the lower extremities
 Fluid retention in the bodyFluid retention in the body
 Feeling of fatigue and of being unwellFeeling of fatigue and of being unwell

12. Pt MedicationsPt Medications
 Immunosuppressive DrugsImmunosuppressive Drugs
 CellceptCellcept
 Cyclosporine A (Sandimmune) (Neoral)Cyclosporine A (Sandimmune) (Neoral)
 FK 506 (Prograf) (Tacrolimus)FK 506 (Prograf) (Tacrolimus)
 Imuran (Azathioprine)Imuran (Azathioprine)
 Mechanism of ActionsMechanism of Actions
 Cause the body to hold salt and waterCause the body to hold salt and water
 Cause the body to lose potassiumCause the body to lose potassium
 May increase hunger and cause weight gain due toMay increase hunger and cause weight gain due to
overeatingovereating
 May increase the amount of sugar, cholesterol, andMay increase the amount of sugar, cholesterol, and
fats in the bloodfats in the blood
 May speed up the thickening and narrowing processMay speed up the thickening and narrowing process
of the blood vessels of the heartof the blood vessels of the heart

13. Medications cont:Medications cont:
 Antihypertensive/Calcium blocker Drugs:Antihypertensive/Calcium blocker Drugs:
 AvaproAvapro
 ClonidineClonidine
 Dynacirc (Isradipine)Dynacirc (Isradipine)
 Lasix (Furosemide)Lasix (Furosemide)
 MetolazoneMetolazone
 Norvasc (Amiodipine besylate)Norvasc (Amiodipine besylate)
 Procardia (Nifedipine)Procardia (Nifedipine)
 Vasotec (Enalapril Maleate)Vasotec (Enalapril Maleate)

14. Causes of Death After CardiacCauses of Death After Cardiac
TransplantationTransplantation
 Of all the complications of cardiacOf all the complications of cardiac
transplantation, these are the fourtransplantation, these are the four
major causes of death:major causes of death:
 Sudden (acute) rejectionSudden (acute) rejection
 Infections other than cytomegalovirusInfections other than cytomegalovirus
 Artery disease in the transplanted heartArtery disease in the transplanted heart
vessels (allograft vasculopathy)vessels (allograft vasculopathy)
 Lymphoma and other malignanciesLymphoma and other malignancies
 These are most likely to occur atThese are most likely to occur at
different timesdifferent times

15. But How Bout We End on a GoodBut How Bout We End on a Good
Note with a Few of the MilestonesNote with a Few of the Milestones
in Heart Transplantations?in Heart Transplantations?
 The longest-living heart transplantThe longest-living heart transplant
recipient, alive and well at age 43, wasrecipient, alive and well at age 43, was
transplanted more than 23 yrs agotransplanted more than 23 yrs ago
 The youngest heart transplant recipientThe youngest heart transplant recipient
was transplanted only three hrs after beingwas transplanted only three hrs after being
born; that person, too, is alive and wellborn; that person, too, is alive and well
more than 14 yrs later.more than 14 yrs later.
 The oldest heart transplant recipient,The oldest heart transplant recipient,
transplanted at age 81, is alive and welltransplanted at age 81, is alive and well
two years later.two years later.