17087 Heart Transplant

Overview

A heart transplant is an operation where a person's badly damaged or failing heart is replaced with a healthy heart from a donor. The donor is someone who has died and whose family agreed to donate their organs. The new heart comes from a person who has been confirmed brain-dead and whose heart is still working. After the surgery, the new heart pumps blood around the body just like a normal heart. A heart transplant is a big step, and it is only offered when other treatments can no longer keep a person's heart working well enough.

No, a heart transplant is not common. It is a specialised procedure carried out in a small number of heart centres. Around the world, several thousand are done each year. Far more people need a transplant than there are donor hearts available, so waiting lists are long and not everyone can be offered one.

Heart transplants are done in people of all ages, from babies to older adults, but most are adults. They are more common in men than in women. In children, the usual reason is a heart problem present from birth or a heart muscle disease. In adults, the usual reason is severe heart failure caused by a weakened heart muscle or damaged heart arteries. Whether a transplant is possible depends on your overall health, your age and other conditions, and it is always decided case by case by a specialist team.

Symptoms

Common symptoms

• Breathlessness, first with exercise and later even at rest or when lying flat
• Feeling very tired or worn out during normal daily activities
• Swelling in the legs, ankles, feet or belly from extra fluid
• Quick weight gain over a few days from fluid build-up
• A cough, especially at night or when lying down
• Dizziness, light-headedness or fainting
• A racing, pounding or fluttering heartbeat
• Needing to get up at night to pass urine, or passing less urine than usual

Symptoms in children

• Poor feeding, sweating during feeds, or tiring quickly while feeding
• Slow weight gain or poor growth
• Fast breathing or grunting
• Blue or grey lips, tongue or skin (called cyanosis), especially in babies with heart problems from birth
• Being unusually sleepy, floppy or irritable
• Sweating a lot, particularly during feeds or play

Symptoms in older adults

• Breathlessness and tiredness that are put down to 'just getting older' but are getting worse
• Confusion, poor concentration or memory problems caused by low oxygen or poor blood flow
• Swollen legs, which may be mistaken for a vein or circulation problem
• Loss of appetite, feeling full quickly, or weight loss
• More falls or unsteadiness, sometimes linked to dizziness or a slow or irregular heartbeat

Causes

Main causes

• Cardiomyopathy: a disease of the heart muscle that makes it weak, stiff or enlarged, so it cannot pump properly
• Coronary artery disease: narrowed or blocked arteries that have damaged the heart muscle, often after heart attacks
• Heart valve disease that has damaged the heart over time
• Congenital heart disease: heart problems present from birth, especially in children
• Heart rhythm problems that cannot be controlled with other treatments
• Heart muscle damage from infections (myocarditis), alcohol, certain medicines or cancer treatments, or rare conditions such as amyloidosis (a build-up of protein in the heart)
• Sometimes no clear cause is found

Risk factors

• A previous heart attack or long-standing high blood pressure
• Diabetes and high cholesterol
• Smoking and heavy alcohol use
• A family history of heart muscle disease or sudden cardiac death
• Some viral infections that affect the heart
• Past chemotherapy or chest radiotherapy
• For problems after a transplant: not taking anti-rejection medicines as prescribed, smoking, and repeated infections

When to see a doctor

See a doctor urgently if:

• New or quickly worsening breathlessness, or breathlessness that wakes you at night
• Rapid weight gain or increasing leg and belly swelling
• Fainting, near-fainting, or a new irregular heartbeat
• After a transplant: fever, feeling shivery or generally unwell, chest pain, or a wound that looks infected
• Any side effect of your medicines that worries you, such as shakiness, severe stomach upset or unusual bruising
• Signs of infection such as a hot, red, swollen area, a persistent cough, or burning when passing urine

Book a routine appointment if:

• Feeling more tired than usual over weeks, or finding everyday tasks harder
• A mild but steady increase in swelling in the ankles or legs
• Questions about your medicines, diet, exercise or travel plans
• Feeling low in mood, anxious or struggling to sleep
• Wanting to talk through what a transplant involves, or what being on the waiting list means

Diagnosis

There is no single test that says you need a heart transplant. Instead, a specialist heart team looks at how well your heart is working, how bad your symptoms are, and whether other treatments have stopped helping. They also check whether your other organs are healthy enough for major surgery and whether you are likely to benefit. This usually means a series of tests over several visits, plus a full review of your health, your home situation and your support network.

Tests that may be done

• Echocardiogram: an ultrasound scan of the heart that shows how well it pumps and whether the valves work
• Electrocardiogram (ECG): a tracing of the heart's electrical signals
• Blood tests to check heart strain, kidney and liver function, blood count, blood sugar, cholesterol and infection
• Chest X-ray
• Cardiac MRI or CT scan for detailed pictures of the heart
• Coronary angiogram: a test using dye and X-rays to look at the heart's arteries
• Exercise or drug stress tests to see how the heart copes under strain
• Lung function tests, since the lungs and heart work closely together
• Blood and tissue typing, plus antibody tests, to match you with a donor heart
• A full health review including dental checks, and sometimes a mental health and social assessment
• For children: growth, feeding and development checks

What to expect at your appointment

You may be seen at a specialist transplant centre. Appointments can be long, and some results take days or weeks. If the team thinks a transplant is right for you, you will be put on a waiting list. Waiting times vary a lot and depend on your blood type, size and how urgently you need a heart. While you wait, you will usually have regular check-ups and may be offered medicines or devices to support your heart.

Treatment

Treatment for severe heart failure aims to control symptoms, keep you as well as possible, and decide whether a transplant is the right option. Many people are helped for months or years by medicines, lifestyle changes and sometimes small implanted devices. A heart transplant is considered when these are no longer enough. After a transplant, treatment focuses on protecting the new heart and keeping you healthy long term.

Self-care at home

• Take all your medicines exactly as prescribed, and never stop them on your own
• Weigh yourself at the same time each morning and write it down, so you and your team spot fluid build-up early
• Limit salt and salty foods, and follow any fluid advice your team gives you
• Stay active within the limits your team recommends, and build up gradually
• Keep up with all appointments, blood tests and check-ups
• Stay away from people with coughs, colds, flu or stomach bugs where you can, and wash your hands often
• Ask your team before starting any new medicine, herbal remedy or supplement, as some can interfere with your medicines
• Do not smoke, and keep alcohol to what your team advises
• Look after your teeth and gums and have regular dental checks
• Keep a simple list of your medicines and who to contact if you feel unwell

Medical treatments

Before a transplant, doctors use a combination of medicines to help the heart pump better, remove extra fluid, control blood pressure and heart rate, and reduce strain on the heart. Some people also have a pacemaker or a small pump device fitted to support the heart while waiting. After a transplant, you will need medicines that calm the immune system so it does not attack the new heart. These are usually taken for life, and the doses are adjusted over time based on blood tests and heart checks. You may also need medicines to protect against infections, to protect the stomach, and to manage blood pressure and cholesterol. Your team will explain what each medicine is for and what side effects to watch for.

When is surgery considered?

A transplant may be offered when severe heart failure is causing symptoms that limit everyday life and other treatments, including medicines and devices, are no longer working well enough. It may also be considered when the heart is expected to fail without warning. Your age, other health problems, your own wishes and the likely benefit are all weighed up. Not everyone is a suitable candidate, and sometimes people are offered other options such as a mechanical heart pump instead.

Living with this condition

Life after a transplant is busy at first. You will have frequent clinic visits, blood tests and heart checks, especially in the first year, and these become less often over time. Many people feel stronger and more able to do things within a few months, though full recovery takes time. You will need to take medicines every day, protect yourself from infection and learn to notice early signs that something is wrong. Most people find a new routine and gradually return to work, hobbies and family life.

Lifestyle tips

• Keep taking your medicines, even when you feel well
• Avoid people with infections, and avoid crowded places if your team advises it, particularly in the early months
• Ask your team about which vaccinations you need and when
• Wear sunscreen and check your skin regularly, as some medicines make skin more sensitive to sun
• Avoid gardening without gloves or handling animal waste where possible
• Tell any doctor, dentist or nurse that you have had a transplant before any treatment
• Carry a card or wear an alert band saying you take anti-rejection medicines
• Get help quickly if you feel unwell, rather than waiting to see if it passes

Diet and exercise

Eating well supports healing and helps control weight, blood pressure and blood sugar. Aim for regular balanced meals with plenty of vegetables, fruit, whole grains, beans and lean protein, and go easy on salt, processed foods and sugary drinks. Food safety matters more after a transplant, so wash produce well, cook meat thoroughly and avoid unpasteurised foods and raw or undercooked eggs. Exercise helps rebuild strength and confidence. Many programmes offer supervised cardiac rehabilitation, and walking is a good place to start. Build up slowly, and ask your team what level of activity is safe for you, especially in the first weeks after surgery.

Mental health and emotional wellbeing

It is very common to feel anxious before the operation and during the wait for a donor heart. Afterwards, some people feel joy and relief, then surprise at feeling low, worried or guilty, especially if the donor heart came from someone who died. Some people have vivid dreams, trouble sleeping, or worry constantly about rejection and infection. These feelings usually ease with time and support. Talking to your team, a counsellor or a psychologist can help a lot, and so can peer support from others who have had a transplant. If you ever have thoughts of harming yourself or feel you cannot cope, please contact your local emergency number or a crisis support service right away. You deserve help immediately.

Prevention

You cannot always prevent needing a heart transplant, because some causes such as inherited heart muscle disease or heart problems from birth are not avoidable. But you can lower your risk of the most common causes of heart damage by looking after your heart: not smoking, keeping active, eating well, keeping blood pressure and cholesterol in a healthy range, limiting alcohol, and getting treated for diabetes if you have it. Prompt treatment of heart problems when they first appear can also delay or prevent severe heart failure.

Vaccines

Vaccinations are an important part of care for people with heart conditions and for anyone who has had a transplant. Your team will advise which ones you need, which may include flu, pneumonia and other routine vaccines, and when to have them. Live vaccines are usually avoided after a transplant, so always check with your transplant team before having any vaccine.

Screening programmes

Regular check-ups for blood pressure, cholesterol, blood sugar and heart health help catch problems early. If you have a family history of heart muscle disease or sudden cardiac death, talk to your doctor about whether relatives should be checked. After a transplant, your team will arrange regular heart checks and screening for other health problems, since anti-rejection medicines can affect the kidneys, blood pressure, bones and skin.

Complications

If left untreated

• Severe heart failure that gets worse over time, making everyday activities very difficult
• Fluid building up in the lungs, which can cause serious breathing problems
• Dangerous heart rhythm problems
• Damage to other organs, such as the kidneys and liver, from poor blood flow
• A much shorter life expectancy without treatment

Long-term outlook

A heart transplant can be life-changing. Most people who have one survive the first year, and many live well for a decade or more. Many say their energy and quality of life improve greatly. The new heart does not last forever, and some people eventually need another transplant or other support, but the aim is to give you as many good years as possible. Your team will be honest with you about what to expect while also helping you plan for the future.

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