Heart Transplant

A heart transplant, or a cardiac transplant, is a surgical transplant procedure performed on patients with end-stage heart failure or severe coronary artery disease when other medical or surgical treatments have failed. As of 2018, the most common procedure is to take a functioning heart, with or without transplanting one or both lungs at the same time, from a recently deceased organ donor (brain death is the standard) and implanting it into the patient. The patient's own heart is either removed and replaced with the donor heart (orthotopic procedure) or, much less commonly, the recipient's diseased heart is left in place to support the donor heart (heterotopic, or "piggyback", transplant procedure).

Approximately 3,500 heart transplants are performed every year in the world, more than half of which occur in the US.[1] Post-operation survival periods average 15 years. Heart transplantation is not considered to be a cure for heart disease but a life-saving treatment intended to improve the quality of life for recipients.

Some patients are less suitable for a heart transplant, especially if they suffer from other circulatory conditions related to their heart condition. The following conditions in a patient increase the chances of complications;

Absolute contraindications:
  • Advanced kidney, lung, or liver disease
  • Active cancer if it is likely to impact the survival of the patient
  • Life-threatening diseases unrelated to heart failure, including acute infection or systemic disease such as systemic lupus erythematosus, sarcoidosis or amyloidosis
  • Vascular disease of the neck and leg arteries.
  • High pulmonary vascular resistance – over 5 or 6 Wood units.
Relative contraindications:
  • Insulin-dependent diabetes with severe organ dysfunction
  • Recent thromboembolism such as stroke
  • Severe obesity
  • Age over 65 years (some variation between centers) – older patients are usually evaluated on an individual basis.
  • Active substance abuse, such as alcohol, recreational drugs or tobacco smoking (which increases the chance of lung disease).

Patients who are in need of a heart transplant but do not qualify may be candidates for an artificial heart or a left ventricular assist device (LVAD).

Post-operative complications include infection, sepsis, organ rejection as well as the side-effects of the immunosuppressive medication. Since the transplanted heart originates from another organism, the recipient's immune system typically attempts to reject it. The risk of rejection never fully goes away, and the patient will be on immunosuppressive drugs for the rest of their life, but these may cause unwanted side effects, such as increased likelihood of infections or development of certain cancers. Recipients can acquire kidney disease from a heart transplant due to side effects of immunosuppressant medications. Many recent advances in reducing complications due to tissue rejection stem from mouse heart transplant procedures.

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