In the recent years, heart transplantation in India has become a ray of hope for many patients suffering from the end stage heart failure or other complex heart conditions.
Thanks to scientific advancements in the area of heart care, outstanding medical expertise and continuous efforts in sensitizing the need for organ donation, heart transplants have become a reality, saving many lives annually.
What Is A Heart Transplant?
Also known as a cardiac transplant, heart transplant is a surgical procedure in which a ‘functioning heart’ from a recently brain-dead patient (the donor) gets implanted it into the patient requiring a ‘new heart’ for survival.
The transplant is usually done either through orthotopic procedure or a less common heterotopic procedure.
Under the orthotopic procedure, the surgeons remove the patient’s repaired heart and replaces it with the donor’s heart where as in heterotopic procedure, the ineffective heart remains in place to support the donor’s heart.
Though the mention of heart transplant was made more than a century ago in 1907, in a paper on Tendencies of Pathology published by the American medical researcher Simon Flexner from the University of Chicago, it still remains a distinct dream for many heart patients, across the globe mostly owing to the lack of donors.
Over a century, the doctors and surgeons have made enormous contributions towards advancing the techniques related to this ultimate life-saving procedure, especially for the benefit of younger ones suffering from congenital heart failures.
After countless number of efforts and failed procedures, the first successful paediatric heart transplant could become a reality only in 1984, at Columbia-Presbyterian Medical Center after surgeons transplanted a heart into a 4-year-old.
As on today, around 3500 heart transplants are done annually worldwide while there are about countless number of patients awaiting their turn.
Who Needs A Heart Transplant?
Patients suffering from very complicated heart conditions including heart failure, dilated cardiomyopathy, restrictive myopathy, coronary artery disease, congenital heart disease, valvular heart disease, hypertrophic cardiomyopathy are referred for a heart transplant.
A heart transplant is usually a last stage procedure when other treatments for these above conditions have failed.
Patients Not Suitable For Heart Transplant
In few cases, patients may not be suitable for a heart transplant due to other complications. Patients suffering from advanced stages of cancer, end stage renal, liver, lung diseases, vascular diseases related to the arteries in neck, legs, acute infections, pulmonary vascular resistance may not be suitable for the procedure.
Doctors also take other factors into consideration like if the patient has been insulin dependent for a long time, recent event of a stroke, obesity, age factor, abuse of tobacco and banned drugs before wheeling the patient into the operation theatre for a heart transplant.
During the recent years, the survival rate has increased, especially in the patients who had undergone orthotropic procedure. The survival rate for more than 5 years post heart transplant has increased by 73.2 per cent in male and is at 69 per cent for the female patients.
Are Complications Common Post Surgery?
Heart is an incredible organ and a heart transplant is an equally phenomenal and challenging procedure that can save a life. However, like all surgeries, complications are common including sepsis, infection and organ rejection despite being on immunosuppressant medications.
What Causes Heart Transplant Rejection?
Immune system guards human body against infections, viruses, bacteria in order to keep it healthy. However, the same response from the immune system can presume the ‘new heart’ as a foreign object and can attack it. It is usually referred as transplant rejection.
Earlier, the survival rate of heart transplant patients used to be very low until the breakthrough in 1983, when cyclosporine, an immunosuppressant medication was introduced. Administered through mouth or intravenously it compromises body’s immune system by decreasing the function of white blood cells.
Doctors prescribe certain medications post-surgery for rest of life to prevent immune system from rejecting the new heart. However, patients on the medication may also suffer transplant rejection.
The next common type is acute cellular rejection in which T-cells, which form the part of immune system start attacking the heart within 3 to 6 months of the transplant.
The rarest form of rejection is humoral also known as acute antibody rejection in which antibodies tend to injure the blood vessels, restricting blood flow to the heart. It can happen anytime from within first month to years after transplant.
Another form of rejection could be chronic that is caused due to coronary artery vasculopathy. In this condition, the thickened inner lining of the blood vessels decrease the flow of blood to the heart muscle, depriving it of oxygen and nutrients.
Causes Behind Heart Transplant Rejection:
Various factors including failure to take prescribed medications, poor lifestyle and dietary habits, genetic mismatch and other unknown causes can contribute towards heart transplant rejection.
Genetic mismatch between the donor and recipient is one of the major risk factors. The initial weeks after heart transplant is a very crucial time and rejection rate decreases in the later months.
Patients high on cholesterol, recipients of the older hearts, coronary heart disease either in the donor or recipient, resistance to insulin up the risk of heart transplant rejection.
Symptoms of Heart Transplant Rejection:
The recipient suffering from heart transplant rejection may experience severe fatigue, shortness of breath, irregular heartbeat, fluid accumulation in feet, ankles and hands, reduced amounts of urine output, unwanted weight gain, nausea to name a few.
It may be sudden without symptoms; a heart attack is usually sign of chronic heart transplant rejection.
Detailed tests and evaluations including blood tests, ECG, echocardiogram form the usual protocol. Acute heart transplant rejection is done through heart biopsy along with blood tests.
In few cases, doctors may recommend coronary angiography, cardiac stress testing to check the functioning of blood vessels.
If not diagnosed on time, heart transplant rejection cause erratic heart rhythm, failure of the new heart, heart attack and could be fatal.
Treatment And Prevention:
The doctors may prescribe anti-rejection medications, antibiotics, for preventing and treating the rejection. In case of humoral rejection, plasmapheresis, a procedure in which antibodies get filtered from the blood can be recommended.
Beta blockers are also prescribed in certain cases.
Heart transplant rejection can be prevented by taking all prescribed medications on time, better control of weight, blood pressure and body temperature, eating healthy, regular exercise, running regular lab tests and reviews by the doctors, avoiding alcohol and tobacco and getting vaccinated against regular infections.