The first heart transplants were performed in the 1960’s, providing hope for certain people who would die under otherwise. The two most common reasons for heart transplantation are coronary heart disease and idiopathic cardiomyopathy. With these conditions, the heart works so hard to pump blood to the entire body that it simply gets tired and wears out. It’s when medicines and mechanical devices do not provide a solution that heart transplantation becomes an option. As with any procedure, though, heart transplants are not without their share of risks.
Before the physical risks even come into play, there are the large financial risks. Coverage by insurance companies vary, and depending on deductibles and co-insurance, patients face a large expense when the procedure is done. The total cost for a transplant varies from place to place, and depends on a number of factors such as lodging, transportation, and complications. However, it is estimated that the surgery and first year of care can run in the $250,000 range. Medical tests and medications after the first year are estimated to be $21,000 per year.
The risk of rejecting the new heart never goes away, and patients will forever need to stay on antirejection medications. This is a leading cause of death in transplant patients during the first year. The recipients immune system attacks the new heart because it sees it as a foreign body. In fact, 25 percent of heart transplant recipients show signs of rejection at least once.
This is actually the most frequent cause of death in the first 30 days after a transplant has been performed. Shock or trauma to the new donor heart, or narrowed blood vessels in the lungs can cause this dysfunction. Thankfully, medication can be used to treat graft dysfunctions.
Heart transplant recipients will need to be on immunosuppressant medications for the rest of their lives. These medications are given to prevent the body from attacking the heart because it sees the new heart as a foreign body. While the medications are working to prevent the body from rejecting the new heart, they are also affecting the body in other ways. These medications also have the potential to cause the following:
– Infection: Immunosuppressants also prevent immune cells from attacking other foreign objects in the body, not just the heart. Patients have an increased risk of developing infections caused by viruses, bacteria and fungus, but the risk is lowered when the doses of medication are lowered. However, patients will always need to make every effort to protect themselves from infection which is one reason why it’s important for patients to live a healthy life style.
– Cancer: Antirejection medications also have the ability to increase the risk of cancer in patients. This includes skin cancer and lymphoma.
– Kidney damage: More than 25 perent of patients experience kidney damage within the first year of transplant.
– High Blood Pressure, Diabetes, High Cholesterol: These are all complications that can arise because of the medications. Even if patients have never had these prior to the procedure the medications can cause them to develop these conditions.
Don’t let these risks scare you, though. Every patient is different and will react to the new heart differently. It’s very important to listen to the doctor and follow a strict regimen of diet, exercise and medication schedule. Diet and exercise can help fight off some of the side effects caused by the medications. Most people find that they need to make a complete lifestyle change, but a healthier way of life certainly seems more appealing than the alternative of death.
Texas Heart Institute
Encyclopedia of Surgery
University of Southern California Keck School of Medicine
National Institute of Health