Heart Transplant Rejection
What is heart transplant rejection?
Your immune system’s job is to seek
out and destroy foreign substances in the body. It destroys bacteria and viruses to help
keep you healthy. Normally, this is a good thing. But sometimes the immune system’s
response can lead to problems.
During a heart transplant, a surgeon removes your badly working heart and replaces it with a healthy heart from a donor. The immune system sees the new heart as a foreign object and can start to attack it. This is known as transplant rejection.
When you have a heart transplant, you will need to take certain medicines for the rest of your life. These help to prevent rejection of the new heart by your immune system. Transplant rejection is very common. It’s common even in people who take all their medicines as prescribed.
The most common type of heart transplant rejection is called acute cellular rejection. This happens when your T-cells (part of your immune system) attack the cells of your new heart. It happens most often in the first 3 to 6 months after transplant.
Humoral rejection is a less common type. It’s also known as acute antibody rejection. It can develop during the first month after transplantation. Or it can happen as late as months to years after transplant. With humoral rejection, antibodies injure the blood vessels in your body, including your coronary arteries. This can cause problems with blood flow to the heart.
Heart transplant rejection can also
be long-term (chronic). Coronary artery vasculopathy is a form of chronic rejection. It
affects the coronary arteries. These supply the heart muscle with oxygen and nutrients.
In coronary artery vasculopathy, the inner lining of the blood vessel thickens. This can
lead to less blood going to the heart muscle. Your healthcare provider may prescribe
certain medicines to prevent and treat this type of rejection.
What causes heart transplant rejection?
Heart transplant rejection can happen in a normally functioning immune system. Failing to take anti-rejection medicines as prescribed can cause transplant rejection. But many people who take their medicines as prescribed still have rejection. No one knows for sure why this happens.
Who is at risk for heart transplant rejection?
Certain things increase the chances
of both short-term (acute) and chronic heart transplant rejection. One of the most
important factors is a genetic mismatch between the heart donor and heart recipient.
Younger heart recipients are also at greater risk for both kinds of rejection.
Other things that specifically
increase the chances of acute transplant rejection include:
Time after transplantation. Rejection
risk is highest several weeks after the transplant and then starts to decrease.
Being a female heart recipient or
female heart donor
Being an African-American heart
Some factors that specifically increase the chances of chronic rejection include:
Older heart donor
History of acute heart rejection
Coronary heart disease in the donor or the recipient
What are the symptoms of heart transplant rejection?
Some of the symptoms of acute heart transplant rejection include:
Feeling tired or weak
Fever or chills
Shortness of breath
Fast or irregular heartbeat
Drop in blood pressure
Swelling of your feet, hands, or ankles
Sudden weight gain
Flu-like aches and pains
Reduced amounts of urine
Dizziness or fainting
Nausea or loss of appetite
It's common for rejection to happen
without any symptoms at all. Because of very intense rules for screening after
transplant, many cases are found before symptoms develop. This is one reason why it is
so important to make all your follow-up visits.
Chronic heart transplant rejection often has no symptoms at all. The first symptom might be a heart attack.
How is heart transplant rejection diagnosed?
Diagnosis starts with a recent health history, physical exam, and blood tests. Often a healthcare provider will diagnose acute rejection with a heart biopsy. You may have multiple routine biopsies after a heart transplant. This helps them to watch for rejection. These biopsies often show signs of transplant rejection before you have any symptoms. Finding a rejection early increases the chances it can be treated.
Sometimes healthcare providers spot acute rejection with a blood test. This test checks for certain genes tied to transplant rejection. Your healthcare provider might use other standard tests to evaluate your heart function. Some examples include:
Other tests are sometimes needed for the diagnosis of chronic rejection. These tests help provide a better look at the blood vessels. These may include:
Cardiac stress testing
How is heart transplant rejection treated?
Treatment depends on a number of factors. These include the severity of the rejection, symptoms, current medicines, and the type of rejection. Some options for treating acute cellular transplant rejection include:
Increasing the dose of or how often
you take a current anti-rejection medicine
Changing to a different anti-rejection medicine
Adding other medicines that suppress
the immune system. This might be prednisone or a similar steroid.
For more severe cases, you may need
treatment with medicines given by IV (intravenous)
Plasmapheresis is the main
treatment for rejection caused by antibodies. This is called acute humoral rejection.
Plasmapheresis filters the blood and removes the harmful antibodies. Sometimes light
therapy to treat the white cells in removed blood is used (photophoresis). The treated
blood is then returned to you.
Increasing the dose of
anti-rejection medicines is another way to treat chronic rejection. If the damage is
more severe, you may have a lot of blockages in the coronary arteries. For this, you may
need angioplasty or open heart surgery. These procedures help blood flow better in the
coronary arteries. Rarely, chronic rejection needs another transplant. Living a
heart-healthy lifestyle can decrease the risk of developing chronic rejection in the
form of coronary artery vasculopathy.
After you get treatment for rejection, you will need to be closely monitored. You might need follow-up tests to see how you respond.
Medicines used to prevent rejection
do suppress the immune system. This increases the risk for infection. Your risk of heart
failure also increases with rejection. Because of these possible complications, your
healthcare provider may:
Give you antibiotic and antiviral medicines. These are needed if you are using certain anti-rejection medicines. They don’t treat the rejection itself, but they may help to prevent infection.
Give you medicines to treat heart
failure, such as beta-blockers. You may need these if the rejection is severely
affecting your new heart.
What are possible complications of heart transplant
In rare cases, heart transplant rejection can cause complications such as:
What can I do to prevent heart transplant rejection?
You can reduce your chances of having heart transplant rejection and complications from rejection. Here are some things you can do:
Take all of your medicines exactly as
Have an adequate supply of your
medicines on hand at all times.
Check your weight, blood pressure, and
temperature as advised by your healthcare provider.
Keep all scheduled healthcare provider
Have your lab work and other tests
done on time.
Contact your transplant team right
away if you have any signs of transplant rejection.
Follow up on any tests with your
Live a heart-healthy lifestyle,
including regular exercise and a healthy diet.
Don't use tobacco products and limit
Stay current on vaccines for the flu and pneumonia, along with
tetanus boosters as needed.
Living with a heart transplant
Your healthcare provider may have
more instructions about how to manage your condition. This might include:
Living a healthy lifestyle. Eat a
heart-healthy diet and get enough exercise. Don't use tobacco products, illegal
drugs, or too much alcohol. Stay at a healthy weight.
Taking other medicines for your heart. These might include medicines to reduce cholesterol, lower your blood pressure, or help manage your blood glucose. Some of these medicines might help lower the chances of chronic rejection as well.
When should I call my healthcare provider?
Call your transplant team right
away if you have any signs of rejection. Also call if you generally don't feel well.
Don't wait until your next scheduled appointment.
Key points about heart transplant rejection
Heart transplant rejection is very
common after heart transplant surgery. Rejection can be acute or chronic. The immune
system attacks the donated heart, leading to symptoms.
Follow all of your healthcare
provider’s instructions carefully. This will help decrease your chances of rejection.
It will also make it easier for your healthcare provider to detect rejection early,
when he or she can treat it more easily.
Know what symptoms might be signs of
heart transplant rejection. Tell your transplant team about any symptoms right
You will need close monitoring to
check for signs of rejection.
The risks of acute rejection lessen
with time, but rejection is always a risk. You will always need anti-rejection
medicines to help prevent transplant rejection.
Anti-rejection medicines suppress your immune system. This
increases your risk for infection.
Treatment of transplant rejection
often involves increasing the dose of medicines you are taking. Your healthcare
provider may add new medicines.
Following a healthy lifestyle can help
keep your heart healthy.
Tips to help you get the most from a visit to your healthcare provider:
Know the reason for your visit and what you want to happen.
Before your visit, write down questions you want answered.
Bring someone with you to help you ask questions and remember what your provider tells you.
At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
Ask if your condition can be treated in other ways.
Know why a test or procedure is recommended and what the results could mean.
Know what to expect if you do not take the medicine or have the test or procedure.
If you have a follow-up appointment, write down the date, time, and purpose for that visit.
Know how you can contact your provider if you have questions.
Online Medical Reviewer:
Online Medical Reviewer:
Mandy Snyder APRN
Online Medical Reviewer:
Steven Kang MD
Date Last Reviewed:
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