Cardiac Transplant Complications

Cardiac Transplant Cardiac Transplant ComplicationsComplications

IntroductionIntroduction

What is a Heart Transplant?What is a Heart Transplant? A heart transplant is an operation in A heart transplant is an operation in

which a heart from someone who has which a heart from someone who has died is placed into another person whose died is placed into another person whose own heart has failed due to severe heart own heart has failed due to severe heart disease.disease.

Over the last decade, cardiac Over the last decade, cardiac transplantation has evolved into the transplantation has evolved into the treatment of choice for many people with treatment of choice for many people with severe heart failure (HF) who continue to severe heart failure (HF) who continue to have symptoms despite maximum have symptoms despite maximum medical therapy.medical therapy.

How Common is Serious How Common is Serious Heart Disease?Heart Disease?

It affects approximately 60 million It affects approximately 60 million people in the United States.people in the United States.

It is the leading killer of all It is the leading killer of all Americans.Americans.

Nearly 750,000 Americans die Nearly 750,000 Americans die each year from heart disease.each year from heart disease.

It is the leading cause of death in It is the leading cause of death in American women, claiming the American women, claiming the lives of nearly 500,000 women lives of nearly 500,000 women each year.each year.

Candidates for Heart Candidates for Heart Transplants May Include:Transplants May Include:

Adults with heart failure that does not Adults with heart failure that does not respond to other available treatmentrespond to other available treatment

Infants and children with congenital Infants and children with congenital heart defects or a disease affecting the heart defects or a disease affecting the heart muscle, called dilated heart muscle, called dilated cardiomyopathycardiomyopathy

People with other types of acute or People with other types of acute or chronic heart problems andchronic heart 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 The majority (52 percent) of candidates are aged 50 to 64; 22 percent are aged are aged 50 to 64; 22 percent are aged 35 to 49.35 to 49.

The pt Evaluation for a The pt Evaluation for a Heart Transplant consist of:Heart Transplant consist of:

Meeting with a transplant Meeting with a transplant surgeon and with a transplant surgeon and with a transplant coordinator at the heart coordinator at the heart transplant centertransplant center

Medical history reviewMedical history review Physical examination by the Physical examination by the

transplant doctortransplant doctor

Pt evaluation cont:Pt evaluation cont:

May also receiveMay also receive Blood tests, including blood and tissue Blood tests, including blood and tissue

typingtyping Evaluation of your heart function, including Evaluation of your heart function, including

echocardiogram and heart catheterizationechocardiogram and heart catheterization Pulmonary function testsPulmonary function tests Evaluation of your kidneys, including a 24-hr Evaluation 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 The wait for a heart transplant may range from 50 days to two years. But range from 50 days to two years. But the average time a candidate spends on the average time a candidate spends on the waiting list is about 266 days.the waiting list is about 266 days.

Complications that May Complications that May Occur with Heart Occur with Heart

Transplants:Transplants: RejectionRejection

The body will attack anything that The body will attack anything that is not its own.is not its own.

Rejection usually occurs in the first Rejection usually occurs in the first six weeks after surgery.six weeks after surgery.

Most common S/S of rejection Most common S/S of rejection may include:may include: Shortness of breathShortness of breath TirednessTiredness FeverFever

Complications cont:Complications cont:

InfectionInfection Immunosuppressant meds. can increase your Immunosuppressant meds. can increase your

chances of certain types of infections.chances of certain types of infections. Lung InfectionsLung Infections

Lungs are the most common site for infections to Lungs are the most common site for infections to develop after any transplant. develop after any transplant.

Daily chest x-rays will be taken for the first few Daily chest x-rays will be taken for the first few days after the surgery and from time to time days after the surgery and from time to time when the pt comes to clinic.when the pt comes to 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


Opportunistic InfectionsOpportunistic Infections Caused by the normal bacteria, viruses, and fungi Caused by the normal bacteria, viruses, and fungi

that float around in the air or normally live on our that float around in the air or normally live on our skinskin

Some of the common opportunistic infections Some of the common opportunistic infections areare

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 It is extremely dangerous to transplant pts if they

haven’t had these diseases and become exposed to haven’t had these diseases and become exposed to any one of them. Special immunizations may be any one of them. Special immunizations may be required within 72 hrs. after exposurerequired within 72 hrs. after exposure

Important sign of these infections is a fever of 100F Important sign of these infections is a fever of 100F or higher for more than 4 hrs or sudden high fever or higher for more than 4 hrs or sudden high fever of 101F or higher.of 101F or higher.


High Blood PressureHigh Blood Pressure High BP can damage the kidneys and High BP can damage the kidneys and

cause strokes and heart attacks.cause strokes and heart attacks. Diabetes MellitusDiabetes Mellitus

Even if the pt never had diabetes, the Even if the pt never had diabetes, the antirejection meds used to suppress the antirejection meds used to suppress the immune system can cause diabetes. Can immune system can cause diabetes. Can also make the control of the pt blood also make the control of the pt blood sugar more difficult.sugar more difficult.

High CholesterolHigh Cholesterol Pt antirejection meds can cause the blood Pt antirejection meds can cause the blood

cholesterol to go up.cholesterol to go up.


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 Thinning of bones due to being ill, poor diet, poor activity, or prednisone (anti-inflammatory agent) and activity, or prednisone (anti-inflammatory agent) and other antirejection medicines.other antirejection medicines.

CataractsCataracts Kidney DiseaseKidney Disease

The main meds and many of the anti inflammatory The main meds and many of the anti inflammatory meds can hurt the kidneys. meds can hurt the kidneys.

If pt is older or if their kidneys have already been If pt is older or if their kidneys have already been injured by illness or medications, permanent kidney injured by illness or medications, permanent kidney damage may occur. This can cause:damage may occur. This can cause:

Edema in the lower extremities Edema 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

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 May increase hunger and cause weight gain

due to overeatingdue to overeating May increase the amount of sugar, cholesterol, May increase the amount of sugar, cholesterol,

and fats in the bloodand fats in the blood May speed up the thickening and narrowing May speed up the thickening and narrowing

process of the blood vessels of the heart process of the blood vessels of the heart

Medications cont:Medications cont:

Antihypertensive/Calcium blocker Antihypertensive/Calcium blocker Drugs: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)

Causes of Death After Causes of Death After Cardiac TransplantationCardiac Transplantation

Of all the complications of cardiac Of all the complications of cardiac transplantation, these are the four transplantation, these are the four major causes of death:major causes of death: Sudden (acute) rejectionSudden (acute) rejection Infections other than Infections other than

cytomegaloviruscytomegalovirus Artery disease in the transplanted Artery disease in the transplanted

heart vessels (allograft vasculopathy)heart vessels (allograft vasculopathy) Lymphoma and other malignanciesLymphoma and other malignancies

These are most likely to occur at These are most likely to occur at different timesdifferent times

But How Bout We End on a But How Bout We End on a Good Note with a Few of the Good Note with a Few of the

Milestones in Heart Milestones in Heart Transplantations?Transplantations?

The longest-living heart transplant The longest-living heart transplant recipient, alive and well at age 43, was recipient, alive and well at age 43, was transplanted more than 23 yrs agotransplanted more than 23 yrs ago

The youngest heart transplant The youngest heart transplant recipient was transplanted only three recipient was transplanted only three hrs after being born; that person, too, hrs after being born; that person, too, is alive and well more than 14 yrs is alive and well more than 14 yrs later.later.

The oldest heart transplant recipient, The oldest heart transplant recipient, transplanted at age 81, is alive and transplanted at age 81, is alive and well two years later.well two years later.

Science

Cardiac Transplant Complications