Heart transplantation should be considered a palliative and not a curative operation. While most patients return to good functional status, transplanted hearts do not last as long as a normal native heart.
Survival rates have continued to improve with experience, better techniques and medications, and improved rejection surveillance and immunosuppression.
Patients must remain on multiple medications for the rest of their lives. One type of medication, immunosuppressants, must be taken forever to help prevent against rejection. Some of these medications can have significant side effects, requiring other medicines for treatment. In the first several months post-transplant it is not unusual for a heart transplant recipient to be on 10 to 15 medicines given multiple times a day. It is critical that the patient adheres strictly to these regimens to avoid the many potential and serious complications of transplantation.
Transplant patients are at risk for infection, and the development of lymphoproliferative disorders (a form of cancer) because of these medications. Rejection may also occur. The dosage of medicines has to be changed at times based on blood tests, evidence of infection or cancer, or evidence of rejection. Close follow-up with the transplant team and doctors is needed and it is not unusual for patients to come back to the hospital often for these assessments.
An aggressive form of coronary artery disease has also been described in transplanted hearts that may represent a form of chronic rejection. This is the most common reason for re-transplantation.
Patients may undergo retransplantation if the transplanted heart starts to fail. Repeat transplants, however, do not always do as well as the first donor heart. If a re-transplant is felt to be needed the patient and family must undergo another evaluation and some patients may not qualify for a retransplant due to medical or social reasons.
The overall survival for orthotopic cardiac transplantation is currently around 90 percent at one year and 80 percent at five years. About 50 percent of transplant recipients make it out more than 15 years.