heart transplant

After heart transplant, what are the survival chances?

Approximately 85 to 90 percent of patients survive for one year post their heart transplant surgery whereas 75 percent of patients survive for three years.

Heart transplantation, also known as cardiac transplantation, has emerged as the only treatment for patients with severe symptoms despite a number of medical therapies. Somehow, the survival rate has increased among the recipients due to increased improvements in treatments.

What are the criteria of heart transplantation?

Heart transplants are done when other treatments fail to treat heart conditions. In adults, there are many reasons for heart failure including coronary artery disease.

The major reason is to increase the survival years of a patient as well as to improve the quality of life. To carry out the heart transplantation procedure, the patient must meet the following criteria:

  • Patient must be less than 69 years.
  • Patient must be diagnosed with end-stage heart diseases such as cardiomyopathy, coronary artery disease, pulmonary hypertension or heart failure.
  • Other than heart impairment, the patient should be infection-free, cancer-free or other organ-impairment as it reduces long-term survival.
  • The patient should not be obese, refrain from alcohol consumption for at least three months prior to the transplant process and post the surgical process.
  • The patient should have a prognosis that implies a significant risk of mortality within a year if the transplant process is not carried out.
  • Patient must have financial and social support to get treated by this surgical procedure. Consult a medical travel assistant company for an estimated heart transplant cost in India.

More than 5,000 heart transplant processes are carried out each year while there are approximately 50,000 patients who need heart transplantation. This simply implies the visible shortage of donors. Therefore, healthcare providers should strictly decide who actually need this transplantation.

Do you know? Spain is one of the countries with the highest number of organ donations in the world. In 2009, it had 34 deceased donors per million population.

Apart from above-mentioned parameters, the other factor to look after while selecting the candidate is the person’s prognosis. Out of many factors, one of the reasonable predictors is the amount of oxygen required by the body known as VO2. This is measured by making the candidate to run on a treadmill. Another predictor is certainly the poor heart functionalities despite proper medical therapy given.

The scenario of transplantation becomes clear when a person requires continual intravenous medications on hospitalization. While for comparatively healthy patients, the following points to look for while considering cardiac transplantation:

  • Frequent visits to the hospital for heart check-ups.
  • Urgent need for ventricular assist device or artificial heart for circulation in the body.
  • Increased doses of medications over a period of time.
  • A reproducible VO2 of less than 14 mL/kg per minute

On the basis of these factors, patients are filtered according to low, medium or high risk of death without performing the transplantation process. Afterward, the final decision is taken by the cardiac transplant team.

What is the Pre-heart transplant evaluation?

Patients who produce the required amount of VO2 and fulfill other heart requirements must be evaluated for other medical problems that refrain the person from getting heart transplantation done. This include:

  • Cancer
  • Infection
  • Pulmonary hypertension

Other factors are the patient’s age, gender, diabetic status, any lung disease, consumption of any form of alcoholic substance, smoke, etc.

What are the conditions that refrain the patient from getting cardiac transplantation done?

  • People between the age of 55 to 60 are excluded from heart transplantation. However, a few of them may show improvement as compared to younger patients. Hence, many centers and hospitals focus on psychologic age which is directly related to the health of some organs such as kidney, liver, heart, etc. and other related medical problems.
  • Diabetes also increases the risk of infections and vascular blood vessel complications. However, diabetic patients with no diabetic-associated complications can also undergo heart transplantation.
  • There is a high chance of infection in lung patients as well. Also, pulmonary embolism with or without infarction also delays transplantation. Most centers primarily focus on pulmonary embolism with anticoagulants for six to eight weeks.
  • Hepatic disease such as cirrhosis also limit survival and increase the risk of death pre and post surgery.
  • Other conditions include advanced peripheral vascular disease – claudication, peptic ulcer, obesity and diverticulosis.

What are the outcomes post the first transplant?

Be its congenital heart disease or any kind of heart disease, the outcomes after the transplant is almost similar.

Do you know? The one-year survival rate in case of congenital heart disease is 79 percent while the five-year survival rate is 60 percent.

For unsuccessful results, lots of factors are responsible that are related to the recipient as well as the donor.

For Recipients: the factors responsible for the death up to one-year post-transplantation include:

  • Need for ventilator pre-surgery.
  • If it’s repetitive heart transplantation for the patient.
  • Severe heart conditions
  • Gender factor: females accept heart transplantation lesser as compared to males.
  • Underweight or obese

For Donors: The factors to be blamed for unsuccessful outcomes are:

  • A female donor is prone to mortality after one-year.
  • If the donor’s heart is left ventricular hypertrophy sufferer, then poorer outcomes are obvious.
  • The donor’s heart should be free from coronary artery disease.

Causes of Death:

Although there are many reasons to be blamed for an increased number of deaths and some of them are:

  • Rejection leading to sudden heart failure.
  • Severe infections
  • Lymphoma and other severe conditions

 

Early Mortality: Frequent episodes of rejections are observed within the first few weeks or months post-surgery. Nearly 50-80 percent of people face at least one rejection episode. In the first year, 18 percent of deaths happen due to acute rejection and 22 percent due to infections.

 

Late Mortality: After the first year, rejection is rare and by four to five years, rejection is responsible for only 10 percent of deaths. Somehow, the development of coronary artery disease and cancer increase over time

Final Thoughts:

Infections still remain the leading cause of death even after the first year. This is due to a weakened immune system. Some people also consider second-time heart transplantation and only 2 percent of transplants are retransplanted every year. However, the survival rate becomes too short which is less than two years. One must look for multiple opinions before undergoing heart transplantation.

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