Longer-term risks of a heart transplant

Infections are very common in the first 12-18 months after a transplant.

As your immune system will be suppressed there is an increased risk of infection. Despite this, bacterial infections are not common late after a transplant.

A virus called CMV (cytomegalovirus) infection, that you can contract from the donated heart, can occur several years after a transplant. Most CMV infections are in the first 12 to 18 months.

Heart transplant patients who have lung disease (like mild emphysema or bronchitis) might notice more frequent chest infection in the winter months. Infection with an organism called pneumocystis is uncommon now that we use prophylactic antibiotics for at least the first 12 months after a transplant.

Some people suffer from more frequent cold sores and shingles. Both are caused by viruses and are treatable with anti-viral tablets.

Learn more about the risk of infections

Learn the risks from the donated heart

This may sometimes develop several months after a heart transplant and it can usually be successfully treated with antibiotics.  

Occasionally one or more of the wires that is used to hold the breastbone together after surgery will need to be removed to encourage healing. This requires a short operation for which you will be admitted to hospital for a day.

The two halves of the breastbone are held together with stainless steel wires after the surgery. The bone heals in about three months after which the wires serve no useful function. They are normally left in place because removing them involves an operation.

This affects 70 to 80 in every 100 patients.

Around 70 to 80 of 100 patients undergoing a heart transplant will need medication to lower blood pressure. This is in contrast to the low blood pressure that you may have experienced when in heart failure. Good control of blood pressure is important for your new heart, for maintaining kidney function, and for avoiding complications like strokes.

This affects around half (50 in 100) of patients within the first 10 years after a transplant.

Cardiac allograft vasculopathy (CAV) is a condition that affects transplanted hearts. It causes the blood vessels supplying blood to the heart muscle itself to become narrowed and eventually blocked.

CAV affects around half of transplanted hearts within the first 10 years. It is one of the main conditions that limit long-term survival after a heart transplant.

Learn more about cardiac allograft vasculopathy

Between 15 to 20 in every 100 patients will develop a skin cancer.

There is a higher risk of some types of cancer following a transplant. Skin cancers are particularly common in heart transplant patients.

What you can do to help prevent skin cancer:

• Avoid staying out in the sun for long periods (more than 15-20 minutes)
• Wear factor 50 sunblock and a long-sleeved shirt and a hat if you are in the sun

Patients who have diabetes before the transplant may find that their blood sugars are more difficult to control in the first 3 to 6 months after the transplant. This is usually due to the immunosuppressant medication, which can increase your blood sugars.

Some patients that weren’t diabetic before the transplant become diabetic following the transplant. This is usually due to the immunosuppressant medication, and also due to weight gain.

This happens in about 1 in 100 patients

In some patients, the breastbone does not heal as expected. This will cause movement between the two halves of the bone and may cause pain on coughing, movement or deep breathing. This may need re-wiring of the bone under general anaesthetic.

Wound healing in heart transplant patients is not as fast as wound healing in other patients. This is because the immunosuppressant tablets slow wound healing. Heavy lifting soon after the transplant can also increase the chance that the bone will not heal. In those patients who have had previous heart surgery, the bone may take longer to heal. You will be advised about what exercise you can undertake in the first few months after the operation, and how much weight you can lift.

In the first 10 years after a heart transplant, 5 to 10 in 100 patients will develop kidney failure that requires dialysis

Kidney dysfunction is common after a heart transplant. Many patients have impaired kidney function when waiting for a transplant and this is often made worse by the transplant operation. Kidney function usually improves in the first week or two after surgery.

Some of the immune suppressant drugs that you are likely to receive (tacrolimus or ciclosporin) have adverse effects on kidney function, especially if level of the drug in your blood stream is high. Your transplant team will carefully monitor your drug levels and kidney function so that appropriate adjustments in dose can be made.

If your kidney function deteriorates late after a transplant (after 6 to 12 months), your team may be able to use an alternative drug, which is less likely to affect kidney function. Over the course of the first ten years after a heart transplant 5 to 10 patients out of 100 will develop kidney failure severe enough to require dialysis. In selected patients with kidney failure, if heart function is well preserved, a kidney transplant may be a possible treatment.

Between 3 to 5 in 100 patients will develop a lymphoma

This is a cancer of the lymph glands and in most patients is caused by a virus. Decreasing the dose of immunosuppression is sometimes enough to control this cancer but most patients will require chemotherapy.

Post-transplant lymphoma is usually caused by a virus called Epstein Barr Virus (EBV). This virus is the cause of glandular fever but is present in most adults and does not usually cause symptoms. When the immune system is suppressed, the virus is allowed to multiply and this can lead to lymphoma. Apart from decreasing immunosuppression, specific drugs that attack certain lymphatic cells help to control the tumour. If this approach is insufficient chemotherapy is required and is often successful.

Some of the immunosuppressant medications can weaken your bones (osteoporosis). This is particularly true for women after the menopause. You will be give medication to prevent osteoporosis and your transplant team will advise you whether you need a bone scan to measure how strong your bones are (“bone density”).

Acute rejection is uncommon after the first year and you will either not need routine heart biopsies or have them much less frequently. Acute rejection can however occur if you miss multiple doses of medication or the level in your blood drops for other reasons (such as persistent vomiting or inability to take medication because of other illness).

One kind of rejection (antibody mediated rejection) can present for the first time late after a transplant and can be difficult to treat. This is a result of your immune system developing antibodies that react with the donor heart.

Learn more about rejection

You will need to take powerful medicines after a heart transplant.

You may experience side effects to your transplant medicines. Different heart transplant centres use different medicines to prevent rejection and infection in their patients. Your own transplant centre will tell you about the medicines they will prescribe after your transplant, and the most common and most important side effects that you need to know about. 

In general, medications for heart transplant patients include:

Immunosuppressants

To reduce the risk of heart rejection.

The doses of these medicines usually reduce over time, but some medicines will be needed for the lifetime of the heart transplant. All immunosuppressants increase the risk of infection, and of some cancers.

Antibiotic and antiviral medicines

To reduce the risk of infection.

These usually stop between 3 and 12 months after a transplant, but your transplant team will advise you about this.

• Medicines to lower blood pressure, reduce blood sugar levels, or reduce the risk of blood clots.
• Medicines to protect the lining of your stomach, as some immunosuppressants and blood thinners can cause stomach irritation 
• Medicines that you may need for other health issues

Learn more about medicines after a heart transplant