Early risks of a heart transplant

90 out of 100 of patients will need a blood transfusion within the first week of surgery.

With any operation there is a risk of bleeding. If it happens during the operation, the surgeon can usually stop it with extra stitches or special medications. Patients who take blood-thinning medications (for example, warfarin) have a higher risk of bleeding.

Sometimes, patients who have had a heart transplant will need to go back to the operating theatre for more surgery to stop the bleeding, as well as having a blood transfusion. This is also common.

A blood transfusion carries risks such as fluid overload, production of antibodies, or (very rarely) disease transmission. Your heart transplant team will discuss these with you.

Out of 100 patients, between 30 and 40 will experience episodes of rejection during the first year after a transplant.

Rejection is when your body’s immune system starts to ‘attack’ your new heart. It happens when your immune system recognises the heart as coming from a different person and thinks it isn’t supposed to be there.

After a heart transplant, patients need to take powerful medications (‘immunosuppressants’) to help stop rejection happening. Even if you take your anti-rejection medications carefully, rejection can still occur. This is why your transplant team will closely monitor your health and heart function after your transplant.

Learn more about rejection

In every 100 patients, between 20 and 30 will experience significant impairment in function of their transplanted heart.

These patients need to have prolonged support with intravenous medications

Heart not pumping on its own

Out of 100 patients, between 15 and 20 will require mechanical circulatory support

This is a machine that helps pumps your blood for you and supports the function of the transplanted heart. This is usually needed for an average of 5 days.

Some heart transplants that need mechanical circulatory support will not recover. Out of 100 patients needing mechanical support early after a heart transplant, 55 will be alive at one year after surgery.

Why is the heart not functioning properly?

The most common reasons for the donor heart function to be severely impaired are:

• Damage during donor brain death, while transporting to the recipient hospital and during implantation. This is called Primary Graft Dysfunction (PGD)
• High pressure within the circulation of the patient’s lung during surgery and immediately after
• Other complications during surgery

Sometimes there is no apparent reason for the heart to not function well.

Between 10 and 20 patients out of 100 will require extra antibiotics for an infection within the first week of heart transplant surgery.

Infections are common after a heart transplant, in part because you will be given immune suppressing medicines. These medicines reduce the risks of you rejecting the donor heart, but they will also lower your immune system’s ability to fight infections.

You are likely to receive antibiotics to prevent infection at the time of surgery and for a few days after. If there is suspicion of infection or you are thought to be at higher risk the antibiotics may continue for longer.

Most infections are easily treated with a week or two of antibiotics. Infections can occur in your chest, urine, or around the plastic tubes inserted through your skin.

Infection of the surgical wound in your chest is also common and may require prolonged antibiotic therapy. Infection of the breast bone, which lies under the surgical wound, is less common (1 in 100 patients) but may require prolonged treatment and, sometimes, surgery.

Rarely, more serious infections can spread to your blood stream.

Learn more about the risk of infections

If you have diabetes before the heart transplant, it is likely that your blood sugar will be more difficult to control after the transplant. Your transplant team will help adjust your medications to improve your blood sugar control.

• If you take tablets to control your diabetes before the transplant, it is possible that you will need insulin to control your diabetes after the transplant.
• You can help lower the risk of diabetes after a transplant by losing weight and exercising.

This affects between 2 to 3 in every 100 heart transplant patients. 

A stroke (a blockage of the blood supply to the brain) can happen soon after a transplant. Strokes are more common in older patients, and in those who have had a stroke before.

It can be a complication of the heart-lung bypass machine, which is used in all heart transplants. It is also more common in those who have complications at surgery such as a poorly functioning heart, associated with low blood pressure. 

Mechanical heart support after surgery requires blood thinning and increases the risk of bleeding in the brain (haemorrhagic stroke).

Mechanical heart support is the use of a machine that helps pumps blood around your body.

1 in 100 patients experience deep vein thrombosis.

Blood clots can form within the deep veins of the leg. These clots can break off and travel in the bloodstream to the hearts, causing heart and heart problems. Blood clots in the deep leg veins are called a deep vein thrombosis (DVT). If they travel to the heart it is called a pulmonary embolus (PE).

How your care team aim to prevent DVT:

• You will be encouraged to get out of bed as soon as you can after a heart transplant to reduce the risk of these blood clots forming.
• Tight stockings help reduce the risk of DVTs and PEs. These should be worn while you are in hospital, and until the transplant team tell you that it is safe to remove them. Some patients should not wear tight stockings, for example if you have major blood flow problems in your leg arteries.
• Blood-thinning medication is usually given to patients after a heart transplant to reduce the risks of DVTs and PEs. However, these blood thinners can increase the risk of bleeding after surgery so a balance needs to be found.

Fewer than 1 in 1000 patients will get cancer from a donated heart.

It is very rare for cancer to be transmitted with the donated heart. Every effort is made to be sure that a donor does not have a cancer that could be passed on to you during a heart transplant. The risk of dying while waiting to receive a heart transplant is much greater than the risk of getting cancer from a transplanted heart.

You may be offered a heart from a donor known to have had cancer. This will only happen if the transplant team think that the risk of the donor’s cancer having spread to the heart is low. This often is the case with some kinds of cancer that are confined to the brain. This will be discussed in detail with you. The risks of getting cancer from these donors is usually higher than 1 in 1000.

This happens in less then 1 in 1000 patients.

It is rare to get a serious infection such as hepatitis B, hepatitis C or HIV from a heart transplant. It is more common that less serious infections such as cytomegalovirus (CMV) are passed on – this infection is usually easy to monitor, diagnose, and treat.

Learn about the risks from a donated heart

Learn more about infections

On average 10 to 12 people out of every 100 patients die in the first few months after a heart transplant. However, this varies widely on a patient-by-patient basis.

There is a risk of dying during a heart transplant operation, or during the first few weeks or months afterwards. This is most common if you develop severe Primary Graft Dysfunction (PGD) and need mechanical support of the heart. Severe infection, stroke, and rarely severe rejection can also be fatal.

Of 100 patients undergoing a heart transplant, about 88-90 will be discharged home and be alive at three months. Most of these will be feeling much better than they did before the transplant. The figure may vary slightly between centres. It is important to remember that your transplant team won’t recommend that you have a transplant if they believe that the benefits do not outweigh the risks.

Find the heart transplant success rate figures for your transplant centre