What Are the Risks of a Heart Transplant?

Although heart transplant surgery is a life-saving measure, it has many risks. Careful monitoring, treatment, and regular medical care can prevent or help manage some of these risks.

Risks of heart transplant include:

• Failure of the donor heart
• Complications from medicines
• Infection
• Cancer
• Problems that arise from not following a lifelong health care plan

Failure of the Donor Heart

Over time, the new heart may fail due to the same reasons that caused the original heart to fail. Failure of the donor heart also can occur if your body rejects the donor heart or if cardiac allograft vasculopathy (CAV) develops. CAV is a blood vessel disease.

Patients who have a heart transplant that fails can be considered for another transplant (called a retransplant).

Primary Graft Dysfunction

The most frequent cause of death in the first 30 days after transplant is primary graft dysfunction. This occurs if the new donor heart fails and isn't able to function.

Factors such as shock or trauma to the donor heart or narrowed blood vessels in the recipient's lungs can cause primary graft dysfunction. Medicines (for example, inhaled nitric oxide and intravenous nitrates) may be used to treat this condition.

Rejection of the Donor Heart

Rejection is one of the leading causes of death in the first year after transplant. The recipient's immune system sees the new heart as a "foreign body" and attacks it.

During the first year, 25 percent of heart transplant patients have signs of a possible rejection at least once. Half of all possible rejections happen in the first 6 weeks after surgery, and most happen within 6 months of surgery.

Cardiac Allograft Vasculopathy

CAV is a chronic (ongoing) disease in which the walls of the coronary arteries in the new heart become thick, hard, and lose their elasticity. CAV can destroy blood circulation in the new heart and cause serious damage.

CAV is a leading cause of donor heart failure and death in the years following transplant surgery. CAV can cause heart attack, heart failure, dangerous arrhythmias, and sudden cardiac arrest.

To detect CAV, your doctor may recommend coronary angiography yearly and other tests, such as stress echocardiography or intravascular ultrasound.

Complications From Medicines

Taking daily medicines that stop the immune system from attacking the new heart is absolutely critical, even though the medicine combinations have serious side effects.

Cyclosporine and other medicines can cause kidney damage. Kidney damage affects more than 25 percent of patients in the first year after transplant. Five percent of transplant patients will develop end-stage kidney disease within 7 years.

Infection

When the immune system—the body's defense system—is suppressed, the risk of infection increases. Infection is a major cause of hospital admission for heart transplant patients and a leading cause of death in the first year after transplant.

Cancer

Suppressing the immune system leaves patients at risk of cancers and malignancies. Malignancies are a major cause of late death in heart transplant patients, accounting for nearly 25 percent of heart transplant deaths 3 years after transplant.

The most common malignancies are tumors of the skin and lips (patients at highest risk are older, male, and fair-skinned) and malignancies in the lymph system, such as non-Hodgkin's lymphoma.

Other Complications

High blood pressure develops in more than 70 percent of heart transplant patients in the first year after transplant and in nearly 95 percent of patients within 5 years.

High levels of cholesterol and triglycerides in the blood develop in more than 50 percent of heart transplant patients in the first year after transplant and in 84 percent of patients within 5 years.

Osteoporosis can develop or worsen in heart transplant patients. This condition thins and weakens the bones.

Complications From Not Following a Lifelong Health Care Plan

Not following a lifelong health care plan increases the risk of all heart transplant complications. Heart transplant patients are asked to closely follow their doctors' instructions and check their own health status throughout their lives.

Lifelong health care includes taking multiple medicines on a strict schedule, watching for signs and symptoms of complications, keeping all medical appointments, and stopping unhealthy behaviors (such as smoking).