Complications of Transplanted Heart

Heart transplantation is a life-saving treatment for people with end-stage heart failure, but it comes with special challenges that require lifelong care and monitoring. While medical teams have years of experience in recognizing and treating these complications, patients play a critical role in managing their health after receiving a new heart.

Table of contents

• Overview of Heart Transplant Complications
• Organ Rejection
• Infections
• Graft Coronary Artery Disease
• High Blood Pressure
• Diabetes
• Early Postoperative Complications
• Chronic Kidney Disease
• Cancer
• Your Role in Prevention

Overview of Heart Transplant Complications

Complications can occur after any surgery, but special complications are associated with heart transplantation. Your medical team has years of experience in recognizing complications and is aware of most things that can happen. They know how to prevent complications and how to treat them if they occur^[1].

Almost all heart transplant recipients will experience at least one complication during their lifetime after transplant. The type and severity of complications can vary greatly, from mild issues that are easily managed to more serious problems that require intensive treatment. How these complications affect your quality of life and survival depends on their severity^[5].

Infection and rejection are the leading causes of death in the first year after transplant^[13]. The risk for developing rejection is highest in the first six months following heart transplantation, with the risk decreasing as time from transplantation increases^[5].

Organ Rejection

Organ rejection occurs when your body’s immune system (the system that protects your body from disease) recognizes the transplanted heart as foreign and tries to attack it. This is one of the most serious complications after heart transplant^[1][12].

The recipient’s body may reject a donor organ through different types of rejection: hyperacute rejection, acute cellular rejection, or antibody-mediated rejection^[5][8]. Rejection can be acute, typically occurring within the first year after transplant, or chronic, developing over a longer period of time.

Several factors can increase your risk of rejection. Women and younger individuals are at higher risk. Patients of Black race also face a higher risk of rejection^[5].

Your body’s immune system identifies the transplanted heart as foreign and mounts an immune response against it. Rejection can occur as early graft dysfunction within the first 24 hours or as late graft dysfunction, developing weeks to years after transplantation^[8].

Regular monitoring is essential to detect rejection early. Your doctor will perform heart biopsies to check for signs of rejection^[15]. These biopsies are done frequently in the months following your transplant and continue at scheduled intervals.

Infections

Infections are a major complication after heart transplant and, along with rejection, are one of the leading causes of death in the first year^[1][12][13].

Because you must take immunosuppressive medications (medicines that weaken your immune system) to prevent rejection, your body’s ability to fight off infections is reduced. This makes you more vulnerable to infections from bacteria, viruses, and fungi^[5].

Smoking adds significant risk to your lungs, which are already at risk for developing lung infections because of the immunosuppressive medications you take. Smoking directly damages the delicate lung tissue and may lead to mucous buildup, coughing, breathing problems, and lung infection^[1][12].

Fever and shortness of breath are among the most common symptoms when heart transplant patients develop complications, including infections^[13]. If you experience these symptoms, you should contact your medical team immediately.

Graft Coronary Artery Disease

Graft coronary artery disease is a condition where the blood vessels of the transplanted heart become narrowed or blocked. This is one of the special complications associated with heart transplantation^[1][12].

This condition develops in the transplanted heart over time and is one of the most frequent complications after heart transplantation, with increasing incidence during post-transplant follow-up^[5].

Regular testing, including coronary angiograms or similar imaging studies, helps your medical team monitor the blood vessels in your transplanted heart and detect this problem early^[14].

High Blood Pressure

High blood pressure, also called hypertension, is a common complication after heart transplant^[1][12].

This condition can develop as a side effect of the immunosuppressive medications you must take to prevent rejection. Your transplant team will prescribe additional medications to help manage high blood pressure^[15].

Regular monitoring of your blood pressure is an important part of your care after transplant. Your medical team will check your blood pressure at every clinic visit and may ask you to monitor it at home.

Diabetes

Diabetes is another potential complication following heart transplantation^[1][12]. Like high blood pressure, diabetes can develop as a side effect of the immunosuppressive medications required after transplant.

Your transplant team may prescribe medications to help manage diabetes if you develop this condition^[15]. Regular blood tests will monitor your blood sugar levels, and your medical team may work with you on dietary changes to help control diabetes.

Early Postoperative Complications

Early complications occur in the immediate period after surgery, within days to weeks of the heart transplant procedure^[13].

These early complications can include abnormal heart rhythms such as arrhythmia, atrial flutter, and atrial fibrillation. Deep wound infections at the surgical site, along with infections at other sites, can also occur. Low cardiac output syndrome (when the heart doesn’t pump enough blood), acute graft dysfunction (when the new heart doesn’t work properly), pericardial effusion (fluid around the heart), constrictive pericarditis (inflammation and stiffening of the sac around the heart), and acute cellular rejection are among the major early complications that require careful monitoring and treatment^[6].

The first few hours to weeks after your heart transplant are a critical time as your body adapts to its new healthy heart. You will need close monitoring after surgery as you recover^[15].

Chronic Kidney Disease

Chronic kidney disease is one of the most common complications that can develop after heart transplant^[5]. The immunosuppressive medications you must take can affect your kidney function over time.

Regular blood work to monitor your kidney function is an essential part of your ongoing care. Your medical team will watch your kidney function closely and may adjust your medications if problems develop.

Cancer

Cancer, also called malignancy, is a complication that can occur after heart transplant, with the risk increasing over time following transplant^[5].

The immunosuppressive medications you take to prevent rejection also reduce your body’s ability to detect and destroy abnormal cells that can become cancer. This increases your risk of developing certain types of cancer compared to people who have not had a transplant.

Regular screening for cancer and careful monitoring by your medical team are important parts of your long-term care after transplant.

Your Role in Prevention

Your role in monitoring your health, following a healthy lifestyle, and taking your medication is critical to preventing and managing complications^[1][12].

You must take anti-rejection medicine every day for the rest of your life to prevent rejection of your new heart. Blood work must also be performed regularly to monitor the side effects of anti-rejection medicine. You should refill your medications on time to avoid missing a dose. You should not take any over-the-counter medications or herbal supplements unless cleared by the transplant team^[15].

Do not smoke. Smoking contributes significantly to the development of heart and lung disease. If you need assistance in locating a program to help you stop smoking, ask your physician or nurse^[1][12].

Watch for warning signs and contact your doctor immediately if you experience symptoms such as redness, swelling, bleeding, drainage, or pain at the incision site; trouble breathing; excessive fatigue; or low blood pressure^[15].

Staying in close contact with your medical team and attending all appointments and procedures can help reduce your risk of side effects and complications^[15]. Most patients will need frequent clinic visits in the months after transplant, including blood draws, echocardiograms, chest X-rays, and heart biopsies^[14].