What complications can happen after my heart transplant?

It is important to remember that transplantation is a serious surgery and does still involve important risks. As with any major operation, there is a risk of both short-term and long-term complications. The most frequent cause of death in the first month after transplant is primary graft dysfunction. This occurs when the transplanted heart fails for unknown reasons and isn’t able to function. This requires urgent retransplantation or the patient will die. Up to 5% of patients do not survive 30 days after their transplant.

According to recent data, however, most patients (approximately 88%) are alive and well after the first year of their new transplant. Rejection and infection are the most common and serious complications after transplantation, especially during that first year. Because of the risk of rejection, you need very careful monitoring and frequent heart muscle biopsies (endomyocardial biopsy). Due to improvements in immunosuppressant medications and diagnostic testing, the rate of posttransplant rejection is decreasing. The prevention, early detection, and treatment of any infection are also crucially important to keeping both you and your new heart healthy.

Over the long term there are many other important health conditions that may develop in patients who have received a heart transplant; these usually occur several years after your transplant. Immunosuppressant medications (antirejection medicines) increase the longterm risk of infections, but these infections can be treated. Your doctors also monitor you carefully for some of the medical problems that can develop after your transplant, specifically high blood pressure, diabetes mellitus, high cholesterol, osteoporosis, kidney disease, cataracts, and cancer.

Immunosuppressant medications can also raise the risk of getting certain types of cancer, especially blood cancer (lymphoma) and skin cancer. Although lymphoma can rarely be fatal, your doctor can lower the risk of developing this by reducing the dosage of your antirejection medicines. About 1 in every 10 transplant patients develops some form of cancer after their heart transplant. Other common forms of cancer (lung, colon, breast, etc.) are not more common in heart transplant patients than they are in the general population.