Cardiac Transplantation Oakville
Cardiac Transplantation
What Is It & Who Needs A Heart Transplantation?
Cardiac Transplantation is a surgical procedure where the failing heart is surgically replaced with a healthier donor heart. It is indicated when heart failure has progressed to the end-stages, and cannot be managed adequately with medications, devices or other surgical methodologies, and the risk of death is high within the next year or two. End stage heart failure can affect other organs, and therefore other organs can be transplanted at the same time at specialized centres, such as lungs , liver and/or kidneys (multiorgan transplant), if indicated.
Multiorgan Transplant May Include:
Heart-Kidney Transplant
This surgery is indicated when irreversible kidney failure occurs in conjunction with heart failure.
Heart Liver Transplantation
This surgery is indicated when irreversible liver conditions exist in addition to heart failure.
Heart-Lung Transplantation
This surgery is indicated when underlying end-stage lung conditions exist, in addition to heart failure.
Because transplantation is a limited resource, there are many exclusionary factors that are considered, prior to becoming eligible for a transplant. It is a decision made by multiple Advanced Heart Failure/Transplant cardiologists and surgeons, after an extensive evaluation.
For those who go on to receive a transplant, close follow-up with lifelong medical therapy is essential, to prevent rejection of the organ(s), and to mitigate new risk factors and complications. The decision to pursue cardiac transplantation is a carefully weighted decision, and even after selecting the appropriate candidates, only half of all those who receive a cardiac transplant, are alive 10 years after the procedure. It is not a cure, but rather a means to improve longevity.
Ideally, management of heart failure by an Advanced HF Cardiologist is of paramount importance, prior to reaching an irreversible stage of end-stage heart failure, in order to delay the progression of heart failure and in some cases negate the need for a transplant; while in other cases, to determine the optimal timing for referral for cardiac transplantation if absolutely needed to prolong the quality of life and duration of survival.
What are Some Complications of Cardiac Transplantation?
Cardiac Allograft Rejection
The recipient of the transplanted organ, will attempt to reject the donor organ, and this risk of rejection will never fully go away. Lifelong immunosuppressant drugs reduce the risk of rejection, but carries with it many adverse effects, such as an increased likelihood of infection, kidney failure, and the development of cancer.
Coronary Allograft Vasculopathy (CAV)
Coronary allograft vasculopathy is an accelerated form of coronary artery disease that develops in the transplanted heart. The donor heart has had its nerve supply severed, and thus the patient may not experience chest pain or typical anginal type symptoms. Instead, symptoms of fatigue, and shortness of breath may occur. CAV affects about half of heart transplant recipients within 10 years, and treatment with the usual atherosclerotic medications, such as statins, have limited efficacy. Ultimately, a second transplantation may be necessary, which carries with it a very high surgical risk, and may not be feasible.
Graft Dysfunction/Failure
The left ventricle of the transplanted heart can develop dysfunction, much like the native heart develops heart failure. This means that the ability to contract, relax, or a combination of both is compromised in the transplanted heart. This can occur days, months or even years after a cardiac transplantation. The most common cause of graft dysfunction after transplantation, is called primary graft dysfunction and this can occur within 24 hours of surgery. Other causes include cardiac allograft rejection, which typically can occur in the first 6-12 months after transplantation, and cardiac allograft vasculopathy (CAV), which can occur at any time.
Arrhythmias
Abnormal heart rhythms, particularly from the upper chambers of the heart (atria) may develop in the transplanted heart, over time.
Infections
There is a higher susceptibility to infections due to the use of immunosuppressive therapies.
Cancer
There are some cancers that can occur, as a result of long term immunosuppressive therapies. These include lymphoproliferative malignancy, and dermatological cancers (squamous and basal cell carcinomas). Long term monitoring by a dermatologist and oncologist is essential for early detection, prevention, and treatment.
The risk of death is the highest in the first year after transplantation, and the reasons include organ rejection, infection and graft failure. After the first year, graft failure remains the most common cause of death. And after five years, cancer becomes the most common cause of death, as the immunosuppressant medications taken to reduce organ rejection may increase the potential of cancerous cells proliferating.
Still have a question about cardiac transplantation? Speak to your doctor about a referral to the Chahal Cardiovascular Centre for an Advanced Heart Failure consultation.
