Patient's Guide to Heart Transplant Surgery

Rejection, Infection, and Complications

Your doctors will only be able to tell whether you have rejection by examining you and taking blood tests. Your doctor and transplant staff will be watching for the following:

1. Rejection
   The risk of rejection never goes away. You will always need to stay on your antirejection medications. The dose of the medications will be decreased, but you should never skip or stop your medications. A biopsy of the heart is the best way to diagnose rejection. This will be done frequently for the first year after your transplant and then will decrease in frequency. More information...
2. Infection
   Immunosuppressant medications can increase your chances of certain types of infections. These infections can be treated but you will need to be aware of fevers, unusual pains, or any other new feelings. As the doses of the antirejection medications are decreased, the risk of infections will also decrease. More information...
3. High Blood Pressure
   High blood pressure is a common problem after transplant. The treatment of high blood pressure is important because high blood pressure can damage your kidneys and cause strokes and heart attacks.
4. Diabetes Mellitus
   Even if you’ve never had diabetes, the antirejection medications used to suppress your immune system can cause diabetes. If you had diabetes before the transplant, the control of your blood sugar may be more difficult.
5. High Cholesterol
   Just like diabetes, the medication used to suppress the immune system can cause the blood cholesterol to go up. High cholesterol is not entirely due to diet high in fatty foods. Your physician may prescribe medication to help control the cholesterol.
6. Reappearance of Heart Disease
   Some forms of heart disease can come back in the transplanted heart. Your doctor and transplant staff will monitor you for signs of this problem.
7. Cancer
   Antirejection medications may increase the risk of cancer. In addition, the antirejection drugs increase the likelihood of skin cancer and blood cancer. The blood cancer, called lymphoma, occurs because of the transplant medications and can cause death. Often, this condition resolves by decreasing your doses of antirejection medicines.
8. Osteoporosis
   This is thinning of the bones due to being ill, poor diet, poor activity, or prednisone and other antirejection medicines. Your doctor will monitor your bones (with a study called a bone density test). You may be placed on medications to help prevent or reduce the possibility of bone thinning.
9. Cataracts
   Prednisone and perhaps some of the other medications that you will be on, or were on, can increase the possibility of cataracts in the eyes. These are spots of tissue within the eyeball that block sight. They can be surgically removed. They cannot really be prevented. Your doctor will ask you to see an ophthalmologist (eye specialist) at least once a year to check for cataracts and for glaucoma (high pressures in the eyeball that can damage your vision).
10. Kidney Disease
    The main medicines used for rejection and many of the medicines used to treat infection can hurt your kidneys. Your doctors will try to make sure you have enough medicine to prevent rejection of your new heart but not so much that it hurts the kidneys. Sometimes this is hard to do. If you are older or if your kidneys have already been injured by illness or medications, permanent kidney damage may occur. This can cause swelling in your feet, fluid retention in your body, and a feeling of fatigue and of being unwell. This can be a very serious problem, so it is very important to have the regular blood tests your doctor may order to check that the levels of your rejection medications are not too high or too low.

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