Heart transplantation

Heart transplantation

What is a Heart Transplant?

How long can you live with a new heart?

What is the survival rate for heart transplant patients?

Why do heart transplant patients die?

Do heart transplants work?

A heart transplant is an operation in which a diseased, failing heart is replaced with a healthier donor heart. Heart transplant is a treatment that's usually reserved for people whose condition hasn't improved enough with medications or other surgeries.

While a heart transplant is a major operation, your chance of survival is good with appropriate follow-up care.


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Before Heart Transplant Surgery

Why it's done

Heart transplants are performed when other treatments for heart problems haven't worked, leading to heart failure. In adults, heart failure can be caused by:

A weakening of the heart muscle (cardiomyopathy)

Coronary artery disease

Heart valve disease

A heart problem you're born with (congenital heart defect)

Dangerous recurring abnormal heart rhythms (ventricular arrhythmias) not controlled by other treatments

Failure of a previous heart transplant

In children, heart failure is most often caused by either a congenital heart defect or cardiomyopathy.

Another organ transplant may be performed at the same time as a heart transplant (multiorgan transplant) in people with certain conditions at select medical centers.

Multiorgan transplants include:

. Heart-kidney transplant. This procedure may be an option for some people with kidney failure in addition to heart failure.

. Heart-liver transplant. This procedure may be an option for people with certain liver and heart conditions.

. Heart-lung transplant. Rarely, doctors may suggest this procedure for some people with severe lung and heart diseases if the conditions cannot be treated with only a heart transplant or a lung transplant.

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How you prepare

How do I get ready for a heart transplant?

Not everyone is a candidate for heart transplant. Because of the wide range of information needed to know if a person is eligible for transplant, a transplant team will review the evaluation. The team includes a transplant surgeon, a transplant cardiologist (doctor specializing in the treatment of the heart), nurse practitioners or physician assistants, one or more transplant nurses, a social worker, and a psychiatrist or psychologist. Other team members may include a dietitian, a chaplain, hospital administrator, and an anesthesiologist (doctor who uses medicines to keep you asleep during surgery).

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The transplant evaluation process will include:

. Psychological and social evaluation. Some psychological and social issues that are involved in organ transplant include stress, financial issues, and support from family or significant others. These factors can greatly affect how you do after the transplant.

. Blood tests. You will need blood tests to help find a good donor match and help improve the chances that the donor heart will not be rejected.

. Diagnostic tests. You will need tests to assess your lungs as well as your overall health. These tests may include X-rays, ultrasound procedures, CT scan, pulmonary function tests (PFTs), and dental exams. Women may get a Pap test, gynecology evaluation, and a mammogram.

. Other preparations. You will get several vaccines to decrease the chances of developing infections that can affect the transplanted heart.

The transplant team will consider all the information from interviews, your health history, the findings from your physical exam, and your diagnostic test results when deciding if you are eligible for a heart transplant.

Once you have been accepted as a transplant candidate, you will be placed on the United Network for Organ Sharing list. When a donor organ becomes available, candidates are selected based on the severity of their condition, body size, and blood type. If the heart is to be yours, you will need to go to the hospital right away so you can get ready for the transplant. (Most hearts must be transplanted within 4 hours after they’ve been removed from the donor.)

These things will need to be done before the transplant:

Your healthcare provider will explain the procedure and let you ask questions.

You will be asked to sign a consent form that gives your permission to do the surgery. Read the form carefully and ask questions if anything is unclear.

You should not eat or drink anything (fast) as soon as you have been told that a heart has become available.

You may be given medicine to help you relax (sedative).

Based on your health condition, your healthcare provider may request other specific preparation.

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Who should avoid undergoing a Heart Transplant?

A heart transplant is not right for everyone. You might not be a good candidate for a heart transplant if you:

Are at an advanced age that would interfere with the ability to recover from transplant surgery.

Have another medical condition that could shorten your life, regardless of receiving a donor heart, such as a serious kidney, liver or lung disease.

Have an active infection

Have a recent personal medical history of cancer

Are unwilling or unable to make lifestyle changes necessary to keep your donor heart healthy, such as not drinking alcohol or not smoking.

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Risks and Complications

What are the risks of a heart transplant?

Besides the risks of having open-heart surgery, which include bleeding, infection and blood clots, risks of a heart transplant include:

. Rejection of the donor heart. One of the most significant risks after a heart transplant is your body rejecting the donor heart.

Your immune system may see your donor heart as a foreign object and try to reject it, which can damage the heart. Every heart transplant recipient receives medications to prevent rejection (immunosuppressants), and as a result, the rate of rejection continues to decrease. Sometimes, a change in medications will halt rejection if it occurs.

To help prevent rejection, it's critical that you always take your medications as prescribed and keep all your appointments with your doctor.

Rejection often occurs without symptoms. To determine whether your body is rejecting the new heart, you'll have frequent heart biopsies during the first year after your transplant. After that, you won't need biopsies as often.

During the biopsy, a tube is inserted into a vein in your neck or groin and directed to your heart. A biopsy device is run through the tube to take a tiny sample of heart tissue, which is examined in a lab.

. Primary graft failure. With this condition, the most frequent cause of death in the first few months after transplant, the donor heart doesn't function.

. Problems with your arteries. After your transplant, it's possible that the walls of the arteries in your heart could thicken and harden, leading to cardiac allograft vasculopathy. This can make blood circulation through your heart difficult and can cause a heart attack, heart failure, heart arrhythmias or sudden cardiac death.

. Medication side effects. The immunosuppressants you'll need to take for the rest of your life can cause serious kidney damage and other problems.

. Cancer. Immunosuppressants can also increase your risk of developing cancer. Taking these medications can put you at a greater risk of skin and lip tumors and non-Hodgkin's lymphoma, among others.

. Infection. Immunosuppressants decrease your ability to fight infection. Many people who have heart transplants have an infection that requires them to be admitted to the hospital in the first year after their transplant.


There can be other complications after a heart transplant. While most of the complications are manageable, the transplant team will monitor you closely during this time.

The most common complications are:

. High blood pressure


Bleeding during or after the surgery

Blood clots that can cause heart attack, stroke, or lung problems

Breathing problems

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During Heart Transplant Surgery

During the procedure

What happens during a heart transplant?

Heart transplant surgery is an open-heart procedure that takes several hours. If you've had previous heart surgeries, the surgery is more complicated and will take longer. Procedures may vary depending on your condition and your healthcare provider's practice.

You'll receive medication that causes you to sleep (general anesthetic) before the procedure. Your surgeons will connect you to a heart-lung bypass machine to keep oxygen-rich blood flowing throughout your body.

Generally, a heart transplant follows this process:

  1. You will be asked to remove any jewelry or other objects that may interfere with the procedure.
  2. You will change into a hospital gown.
  3. A healthcare professional will start an intravenous (IV) line in your hand or arm to inject medicine and to give IV fluids. Additional catheters will be put in blood vessels in your neck and wrist to monitor the status of your heart and blood pressure, and to take blood samples. Other sites for the additional catheters include the under the collarbone and the groin.
  4. A soft, flexible tube (Foley catheter) will be put into your bladder to drain urine.
  5. A tube will be put through your mouth or nose into your stomach to drain stomach fluids.
  6. If there is a lot of hair on your chest, it may be shaved.
  7. Heart transplant surgery will be done while you are in a deep asleep (under general anesthesia). Once you are asleep, a breathing tube will be put through your mouth into your lungs. The tube will be attached to a machine (ventilator) that will breathe for you during the surgery.
  8. The anesthesiologist will watch your heart rate, blood pressure, and blood oxygen level during the surgery.
  9. The skin over your chest will be cleaned with an antiseptic solution.
  10. The surgeon will make a cut (incision) down the center of your chest from just below the Adam's apple to just above the navel.
  11. The surgeon will cut the breastbone (sternum) in half. He or she will separate the two halves of the breastbone and spread them apart to reach your heart.
  12. The surgeon will put tubes into your chest so that your blood can be pumped through your body by a heart-lung (cardiopulmonary bypass) machine while your heart is stopped and replaced.
  13. Once the blood has been completely diverted into the bypass machine and is being pumped by the machine, your doctor will remove the diseased heart.
  14. The surgeon will sew the donor heart into place. Once your new heart is in place, he or she will connect the blood vessels carefully so there are no leaks.
  15. When your new heart is fully connected, the blood circulating through the bypass machine will be allowed back into the heart and the tubes to the machine are removed. Your surgeon will shock the heart with small paddles to restart the heartbeat.
  16. Once your new heart starts to beat, the healthcare team will watch the heart to see how it’s working and make sure there are no leaks.
  17. Wires for pacing may be put into the heart. Your surgeon can attach these wires to a pacemaker outside your body for a short time to pace your new heart, if needed, during the initial recovery period.
  18. The surgeon will rejoin the sternum and sew it together with small wires.
  19. The surgeon will sew the skin over the sternum back together. He or she will use sutures or surgical staples to close the incision.
  20. Tubes will be put into your chest to drain blood and other fluids from around the heart. These tubes will be connected to a suction device to drain fluids away from the heart as it heals.
  21. A sterile bandage or dressing will be applied.

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After Heart Transplant Surgery

After the procedure

You'll initially stay in the intensive care unit (ICU) for a few days, then be moved to a regular hospital room. You're likely to remain in the hospital for a week or two. The amount of time spent in the ICU and in the hospital varies from person to person.

After you leave the hospital, your transplant team will monitor you at your outpatient transplant center. Due to the frequency and intensity of the monitoring, many people stay close to the transplant center for the first three months. Afterward, the follow-up visits are less frequent, and it's easier to travel back and forth.

You'll also be monitored for any signs or symptoms of rejection, such as shortness of breath, fever, fatigue, not urinating as much or weight gain. It's important to let your transplant team know if you notice any signs or symptoms of rejection or infection.

To determine whether your body is rejecting the new heart, you'll have frequent heart biopsies in the first few months after heart transplantation, when rejection is most likely to occur. The frequency of necessary biopsies decreases over time.

During a heart biopsy, a doctor inserts a tube into a vein in your neck or groin and directs it to your heart. The doctor runs a biopsy device through the tube to remove a tiny sample of heart tissue, which is examined in a lab.

You'll need to make several long-term adjustments after you have had your heart transplant. These include:

. Taking immunosuppressants. These medications decrease the activity of your immune system to prevent it from attacking your donated heart. You'll take some of these medications for the rest of your life.

Because immunosuppressants render your body more vulnerable to infection, your doctor might also prescribe antibacterial, antiviral and antifungal medications. Some drugs could worsen — or raise your risk of developing — conditions such as high blood pressure, high cholesterol, cancer or diabetes.

Over time, as the risk of rejection decreases, the doses and number of anti-rejection drugs can be reduced.

. Managing medications, therapies and a lifelong care plan. After a heart transplant, taking all your medications as your doctor instructs and following a lifelong care plan are vital.

Your doctor might give you instructions regarding your lifestyle, such as wearing sunscreen, not using tobacco products, exercising, eating a healthy diet and being careful to lower your risk of infection.

Follow all of your doctor's instructions, see your doctor regularly for follow-up appointments, and let your doctor know if you have signs or symptoms of complications.

It's a good idea to set up a daily routine for taking your medications so that you don't forget. Keep a list of all your medications with you at all times in case you need emergency medical attention, and tell all your doctors what you take each time you're prescribed a new medicine.

. Cardiac rehabilitation. These programs incorporate exercise and education to help you improve your health and recover after a heart transplant. Cardiac rehabilitation, which you might start before you're released from the hospital, can help you regain your strength and improve your quality of life.

Diet and nutrition

After your heart transplant, you may need to adjust your diet to keep your heart healthy and functioning well. Maintaining a healthy weight through diet and exercise can help you avoid complications such as high blood pressure, heart disease and diabetes.

A nutrition specialist (dietitian) can discuss your nutrition and diet needs and answer any questions you have after your transplant. Your dietitian will provide you with several healthy food options and ideas to use in your eating plan. Your dietitian's recommendations may include:

Eating plenty of fruits and vegetables each day

Eating whole-grain breads, cereals and other grains

Drinking low-fat or fat-free milk or eating other low-fat or fat-free dairy products, to help maintain enough calcium in your body.

Eating lean meats, such as fish or poultry

Maintaining a low-salt diet

Avoiding unhealthy fats, such as saturated fats or trans fats

Avoiding grapefruit and grapefruit juice due to its effect on a group of immunosuppressant medications (calcineurin inhibitors).

Avoiding excessive alcohol

Staying hydrated by drinking adequate water and other fluids each day

Following food safety guidelines to reduce the risk of infection


After your heart transplant, your doctor and treatment team may recommend that you make exercise and physical activity a regular part of your life to continue to improve your overall physical and mental health.

Exercising regularly can help you control your blood pressure, reduce stress, maintain a healthy weight, strengthen your bones and increase your physical function.

Your treatment team will create an exercise program designed to meet your individual needs and goals. You'll participate in cardiac rehabilitation to help improve your endurance, strength and energy. Cardiac rehabilitation incorporates education and exercise to help you improve your health and recover after your heart transplant.

Your exercise program may include warm-up exercises such as stretching or slow walking. Your treatment team may suggest physical activities such as walking, bicycling and strength training as part of your exercise program. Specialists in the treatment team will likely recommend you cool down after you exercise, perhaps by walking slowly. Discuss with your treatment team what activities may be appropriate for you.

Take a break from exercising if you feel tired. If you feel symptoms such as shortness of breath, nausea, irregular heart rate or dizziness, stop exercising. If your symptoms don't go away, contact your doctor right away.


Most people who receive a heart transplant enjoy a good quality of life. Depending on your condition, you may be able to resume many of your daily life activities, such as returning to work, participating in hobbies and sports, and exercising. Discuss with your doctor what activities are appropriate for you.

Some women who have had heart transplants can become pregnant. However, talk to your doctor if you're considering having children after your transplant. You'll likely need medication adjustments before becoming pregnant, as some medications can cause pregnancy complications.

Survival rates after heart transplantation vary based on a number of factors. Survival rates continue to improve despite an increase in older and higher risk heart transplant recipients. Worldwide, the overall survival rate is more than 85% after one year and about 69% after five years for adults.

What if your new heart fails?

Heart transplants aren't successful for everyone. Your new heart can fail for a number of reasons. Your doctor might then recommend adjusting your medications or, in more extreme cases, having another heart transplant.

If additional treatment options are limited, you might choose to stop treatment. Discussions with your heart transplant team, doctor and family should address your expectations and preferences for treatment, emergency care and end-of-life care.

How long can you live with a new heart?

How long you live after a heart transplant depends on many factors, including age, general health, and response to the transplant. show that among all people who have a heart transplant, half are alive 11 years after transplant surgery. Of those who survive the first year, half are alive 13.5 years after a transplant.

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What is the survival rate for heart transplant patients?

Survival rates after heart transplantation vary based on a number of factors. Survival rates continue to improve despite an increase in older and higher risk heart transplant recipients. Worldwide, the overall survival rate is more than 85% after one year and about 69% after five years for adults, In general, though, statistics show that among all people who have a heart transplant, half are alive 11 years after transplant surgery. Of those who survive the first year, half are alive 13.5 years after a transplant.

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Why do heart transplant patients die?

Heart transplant prolongs the life of people who would otherwise die. About 80% of heart transplant patients are alive 2 years after the operation. At 5 years, 70% of patients will still be alive after a heart transplant, The prime causes of death were mostly postoperative graft failure (whose effects brought about 64% of peri-operative deaths, 28% of early and 7% of intermediate deaths), post-operative complications (10% of peri-operative deaths), acute rejection (10% of total deaths, distributed in all the periods), graft arteriopathy (6% of early, 36% of intermediate and 58% of late deaths), infections (17% of deaths, occurring in all periods but late) and malignant tumours (7% of deaths), lymphomas being the first to occur and Kaposi's sarcoma occurring only in the intermediate period. Repeat transplantation had a poor outcome (death rate 71.4%), two-thirds of the re-transplanted patients' deaths being due to early graft failure and a third to late relapsing graft vasculopathy.

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Do heart transplants work?

A heart transplant is an operation in which a diseased, failing heart is replaced with a healthier donor heart. Heart transplant is a treatment that's usually reserved for people whose condition hasn't improved enough with medications or other surgeries.

While a heart transplant is a major operation, your chance of survival is good with appropriate follow-up care. About 80% of heart transplant patients are alive 2 years after the operation. At 5 years, 70% of patients will still be alive after a heart transplant. The main problem, as with other transplants, is rejection.

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