Post-operative medication considerations in cardiac transplant patients
Abstract
The first successful heart transplant was carried out in 1979, and there are now approximately 200 transplants undertaken in the UK each year. Many medications are used to prevent rejection of the transplanted organ, but this needs to be balanced with the risk of complications of immunosuppression, such as infection, organ dysfunction, graft dysfunction and vasculopathy. Patients must be able to adhere to the complex and vast regimen of medications started post-transplant, and extensive monitoring is required to ensure the correct balance of rejection risk and adverse effects, depending on where the patient is in their postoperative journey. Immediately after the transplant is when the patient is at highest risk of rejecting their new heart. Guidance is available to recommend regimens to prevent rejection, but needs to be adapted to each patient, taking into consideration their clinical picture, together with comorbidities, drug interactions and organ dysfunction.
Cardiac transplantation is considered for patients who have severe heart failure and in whom conservative medical treatments are failing to improve their condition. Some conditions indicated to be resolved with a transplant include coronary heart disease, cardiomyopathy and congenital heart disease. Cardiac transplantation is a major surgery and complications can be life threatening. In some instances, patients may end up on mechanical circulatory support such as extracorporeal membrane oxygenation (ECMO) or a ventricular assist device (VAD).
Around 80–90 in every 100 people will live at least a year post-transplant and 70–75 in every 100 will live to at least 5 years (NHS Blood and Transport, 2024). Patients must be able to withstand such a big operation, and pre-operative assessment includes mobility by the physiotherapy team, nutritional status by dietitians and a thorough psychological and physical assessment. Tests such as tissue typing, ECHO, ECG, virology screen, DEXA scan and pulmonary function tests, in addition to many others, are also needed for assessment prior to cardiac transplant, to assess suitability.
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