Heart and Lung Transplant (cont.)
Francisco Talavera, PharmD, PhD
Your chances for recovery from heart and lung transplants today are improved greatly since the first transplant operations done in the 70s and 80s.
- With advances in surgical techniques and immune-suppressing drugs, more than 70% of heart recipients survive more than 3 years after the operation.
- Lung transplantation is a relatively new procedure that continues to be improved. Currently, more than 50% of lung recipients survive at least 3 years after a transplant.
Overall, transplantation leads to improvement in your well-being because you regain the ability to carry out normal activities.
Rejection of the transplanted organ and infections are the most serious complications after this procedure. Different complications occur at different times after the operation.
- In the first few weeks after transplantation, bacterial lung infections are common in people who have heart and lung transplantation. These are treated with antibiotics. Fungal infections may also occur early after transplant but are less common.
- In the second month after transplant, cytomegalovirus (CMV) lung infections are common. You may receive antiviral medications to prevent this infection.
Acute rejection occurs within days after the transplant operation.
- Signs of heart rejection include fatigue, swelling of the arms or legs, weight gain, and fever.
- After a heart transplant, you are monitored for acute rejection by taking a tiny piece of heart muscle called a biopsy and examining it with a microscope.
- Signs of lung rejection include cough, shortness of breath, fever, elevated white blood cell count, and a feeling of not getting enough oxygen.
- After a lung transplant, doctors may need to check the lung tissue by using a long flexible tube with a tiny camera on the end (bronchoscopy).
- If you have any signs of rejecting the transplanted organ, you will be given powerful immunosuppressive medications to stop the rejection.
Rejection of the transplanted organ can also occur months or years later.
- Rejection occurring months or years later is called chronic rejection. Signs are similar to those of acute rejection but are often slow to develop.
- Chronic lung rejection usually occurs because of fibrosis (hardening) of the smaller airways and blockages. This process is sometimes called bronchiolitis obliterans syndrome and can be very serious.
- Treatment includes altering the immunosuppressive medications or retransplantation.
- Chronic rejection of the heart occurs because of development of blockage of the coronary arteries in the transplanted heart. Unfortunately, the cause remains unknown and retransplantation is the only solution. Patients will have all symptoms of heart failure. With a lack of organ donors, retransplantation is not common.
- Some transplant specialists believe that chronic rejection is a long-term complication brought on by acute rejection. For this reason, contact with the transplantation team about any new symptoms is very important.