Contraindications
When determining the indication for heart transplantation, contraindications that preclude HTX must be considered. These include active infectious diseases such as HIV, cancers not treated curatively (with the prospect of cure) (malignancies), currently florid ulcers in the stomach or intestine, advanced insufficiency of the liver or kidney, advanced chronic lung diseases, Acute pulmonary embolism, advanced cerebral or peripheral vascular disease (pAVK), certain systemic diseases such as amyloidosis or sarcoidosis, severe fixed pulmonary hypertension (pulmonary hypertension) and current severe nicotine, alcohol or drug abuse.A lack of compliance, which leads to the assumption that the responsible handling of one’s own health and the observance of regulations after the operation is not sufficiently guaranteed, is also considered a contraindication.
Complications
With regard to the complications of a heart transplantation, a distinction must be made between those of the actual operation, which can be triggered by the foreign organ, and those which can result from immunosuppressive therapy. The risks of surgery are similar to those of other operations, including bleeding, infection, thrombosis/pulmonary embolism and – in rare cases – death of the patient. A very important aspect of the transplantation of a foreign organ is the rejection of the organ.
In order to avoid these, the patient is treated with permanent immunosuppressive therapy. Nevertheless, rejection reactions can occur. A rough distinction is made between acute and chronic rejection, with chronic rejection occurring later and often much less noticeable.
The acute reaction can manifest itself, among other things, through fever, malaise, reduced resilience, weight gain due to water retention (edema) and irregular heartbeat (cardiac arrhythmia). Therefore, temperature, pulse and weight should be measured and recorded daily. In addition, after the transplantation there are often follow-up examinations at the beginning, during which blood is taken and examinations such as ECG (electrocardiography), heart ultrasound (echocardiography) and heart muscle biopsy (taking a sample of a small piece of the heart muscle) are carried out.
In this way, rejection reactions can be detected in time and treated by adjusting the immunosuppressive therapy. The drugs that are taken to suppress the body’s own immune system have side effects that should not be underestimated. In particular, the risk of infection is increased because the body is prevented from reacting as strongly as usual to invading pathogens.
Treatment is usually a triple therapy, which regularly includes Ciclosporin and Prednisolon. Other side effects of Ciclosporin include high blood pressure (hypertension) and, over the course of several years, the development of cancer. In addition to increased susceptibility to infections, prednisolone therapy can lead to osteoporosis, weight gain, development of diabetes mellitus, muscle weakness, depression, gastrointestinal ulcers, high blood pressure (hypertension), glaucoma and cataracts.
