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Your immune system’s job is to seek out and destroy foreign substances in the body. It destroys bacteria and viruses to help keep you healthy. Normally, this is a good thing, but sometimes the immune system’s response can lead to problems.
During a heart transplant, a surgeon removes your badly working heart and replaces it with a healthy heart from a donor. The immune system sees the new heart as a foreign object and can start to attack it. This is known as transplant rejection.
When you have a heart transplant, you will need to take certain medicines for the rest of your life. These help to prevent rejection of the new heart by your immune system. Transplant rejection is very common. It’s common even in people who take all their medicines as prescribed.
The most common type of heart transplant rejection is called acute cellular rejection. This happens when your T-cells (part of your immune system) attack the cells of your new heart. It happens most often in the first 3 to 6 months after transplant.
Humoral rejection is a less common type. It’s also known as acute antibody rejection. It can develop during the first month after transplantation. Or it can happen as late as months to years after transplant. With humoral rejection, antibodies injure the blood vessels in your body, including your coronary arteries. This can cause problems with blood flow to the heart.
Heart transplant rejection can also be chronic. Coronary artery vasculopathy is a form of chronic rejection. It affects the coronary arteries. These supply the heart muscle with oxygen and nutrients. In coronary artery vasculopathy, the inner lining of the blood vessel thickens. This can lead to less blood going to the heart muscle. Your healthcare provider may prescribe certain medicines to prevent and treat this type of rejection.
Heart transplant rejection can happen in a normally functioning immune system. Failing to take anti-rejection medicines as prescribed can cause transplant rejection. But many people who take their medicines as prescribed still have rejection. No one knows for sure why this happens.
Certain things increase the chances of both acute and chronic heart transplant rejection. One of the most important factors is a genetic mismatch between the heart donor and heart recipient. Younger heart recipients are also at greater risk for both kinds of rejection.
Other factors that specifically increase the chances of acute transplant rejection include:
Some factors that specifically increase the chances of chronic rejection include:
Some of the symptoms of acute heart transplant rejection include:
It is common for rejection to happen without any symptoms at all. Because of very intense rules for screening after transplant, many cases are found before symptoms develop. This is one reason why it is so important to make all your follow-up visits.
Chronic heart transplant rejection often has no symptoms at all. The first symptom might be a heart attack.
Diagnosis starts with a recent health history, physical exam, and blood tests. Often a healthcare provider will diagnose acute rejection with a heart biopsy. You may have multiple routine biopsies after a heart transplant. This helps them to watch for rejection. These biopsies often show signs of transplant rejection before you have any symptoms. Finding a rejection early increases the chances it can be treated.
Sometimes healthcare providers spot acute rejection with a blood test. This test checks for certain genes tied to transplant rejection. Your healthcare provider might use other standard tests to evaluate your heart function. Some examples include:
Other tests are sometimes needed for the diagnosis of chronic rejection. These tests help provide a better look at the blood vessels. These may include:
Treatment depends on a number of factors. These include the severity of the rejection, symptoms, current medicines, and the type of rejection. Some options for treating acute cellular transplant rejection include:
Plasmapheresis is the main treatment for rejection mediated by antibodies. This is called acute humoral rejection. Plasmapheresis filters the blood and removes the harmful antibodies.
Increasing the dose of anti-rejection medicines is another way to treat chronic rejection. If the damage is more severe, with significant blockages in the coronary arteries, you may need angioplasty or open heart surgery. These procedures help provide greater flow to the coronary arteries. Rarely, chronic rejection requires another transplant. Living a heart healthy lifestyle can decrease the risk of developing chronic rejection in the form of coronary artery vasculopathy.
After you get treatment for rejection, you will need to be closely monitored. You might need follow-up tests to see how you respond.
Medicines used to prevent rejection do suppress the immune system. This increases the risk for infection. Your risk of heart failure also increases with rejection. Due to these possible complications, your healthcare provider may:
In rare cases, heart transplant rejection can cause complications such as:
You can reduce your chances of having heart transplant rejection and complications from rejection. Here are some things you can do:
Your healthcare provider may have further instructions about how to manage your condition. This might include:
Call your transplant team right away if you have any signs of rejection. Also call if you generally do not feel well. Do not wait until your next scheduled appointment.
Tips to help you get the most from a visit to your healthcare provider:
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