Can a heart be rejected after a transplant? (Heart Transplant Rejection) Let's talk about this!

You see, getting a new heart is like starting a new life. This is a great relief, especially for someone whose heart function has become very weak, that is, end-stage heart failure . However, sometimes our body sees this new heart as a "stranger" and starts to react against it. That's what we call Heart Transplant Rejection . Although this is a bit scary, being properly informed about this can reduce many problems. So let's talk about this in detail today, shall we?

What exactly is Heart Transplant Rejection?

Simply put, a heart transplant is a surgical procedure in which a heart that is in a serious condition is removed and a healthy heart from a deceased donor is transplanted. So, when your body's immune system recognizes the new heart as "not yours, but someone else's," it starts attacking the new heart as if it were fighting a disease. That's what rejection is.

This is most likely to happen within the first few weeks after implantation. However, sometimes this condition can occur months or even years later.

The most important thing is that before the heart transplant, doctors will start you on immunosuppressant medications . These medications try to suppress your body's immune system and stop it from attacking the new heart. However, sometimes even with these medications, rejection cannot be completely stopped.

Rejection can lead to a number of complications. For example:

• Heart rhythm irregularities (Arrhythmia): This can lead to sudden death.
• Failure of the new heart to function.
• Having a heart attack.

What are the main types of rejection?

There are three main types of rejection seen in heart transplants:

1. Acute cellular rejection: This occurs when a special type of cell in your immune system called T cells attacks the new heart cells. This is most common during the first three to six months after the transplant.

2. Chronic rejection: This is caused by the immune system continuing to attack the graft over time. In most cases, the main blood vessels that supply blood to the heart, the coronary arteries, gradually become thickened. This reduces the amount of oxygen and nutrients the heart needs.

3. Humoral rejection: This is also called acute antibody rejection . This can happen at any time after the transplant. What happens here is that antibodies produced by your immune system damage the blood vessels of the new heart. This prevents the heart from getting enough blood.

How common is this heart rejection?

In fact, this rejection is something that can be seen to some extent among people who have had a heart transplant. This can sometimes happen even if they take immunosuppressant medications correctly. However, the good news is that with the advancement of medical science, especially with the discovery of new things about immunosuppression , the risk of this rejection is gradually decreasing.

What factors increase the risk of heart rejection?

There are some things that can increase the risk of rejection. Let's see what they are:

• Some health conditions that a heart recipient has: For example , high cholesterol , insulin resistance , and pulmonary hypertension .
• Genetic mismatch between the donor and the recipient.
• If the person who donated the heart had a heart condition.
• If something happens to the heart while it is being removed from the body, brought back, and transplanted into a new person.
• The person receiving the heart is black (this is something that has been found in studies, it is not common to everyone).
• If the person receiving the heart is much younger than the person giving the heart.
• Immunosuppressive medications not being taken at the correct dose, at the correct time, or not working properly with another new medication.

What causes hearts to reject?

This happens because your body's immune system recognizes the new heart as a "foreign thing." It then sends out T cells, or antibodies , to attack the "invader."

This can happen despite the antirejection drugs given to heart transplant patients. Scientists still don't fully understand exactly why this happens.

What are the symptoms of heart rejection?

This is the most confusing part. Sometimes heart failure can occur without any symptoms! That's why doctors keep testing you, to see if there's anything wrong. However, some people do develop symptoms.

Common symptoms of a fever include:

• Abdominal pain.
• Body pain.
• Chills.
• Very tired (Fatigue).
• Low fever, as if the body is overheated.
• Nausea or loss of appetite.
• Feeling unwell.

There may also be other symptoms:

• Dizziness or fainting.
• Heart palpitations , rapid or irregular heartbeat.
• Less than normal urine output (Oliguria) .
• Low blood pressure (Hypotension) .
• Difficulty breathing (Dyspnea) .
• Sudden, unexpected weight gain.
• Swelling of the ankles, hands, or feet.

If you experience any of these signs, you should notify your doctor immediately, without waiting for your next appointment.

How do you recognize heart rejection?

After your heart transplant, you will have regular tests to check for rejection. Your doctors may order tests such as:

• Blood tests to check for DNA markers associated with rejection.
• An echocardiogram (like an ultrasound scan of the heart).
• Electrocardiogram (ECG or EKG) test (checking the electrical activity of the heart).
• Nuclear cardiac stress test .
• Angiography ( an X-ray that looks at the blood vessels of the heart).
• Intravascular ultrasound .
• Myocardial biopsy or heart biopsy: This involves taking a very small piece of tissue from the heart and examining it under a microscope for signs of rejection. This is the best way to confirm rejection.

What to do if there is a heart rejection?

The treatment method depends on many factors, for example:

• Type of rejection.
• The severity of rejection.
• Your symptoms.
• Other health problems you have.
• What medications are you currently taking?

If you have heart rejection, doctors may do things like:

• Changing the types of immunosuppressant drugs you are currently taking, adding new ones, or increasing the dosage.
• A treatment called plasmapheresis or photopheresis, which is a method of purifying your blood.
• Surgery or other procedures to improve blood flow, such as angioplasty or open-heart surgery.
• Prescribing medications from the corticosteroid group, for example , Prednisone .
• Taking a heart from a new donor and performing a retransplant (this is very rare).
• Using machines to support your heart, such as an extracorporeal membrane oxygenator (ECMO) or a ventricular assist device (VAD) .

What can I do to prevent heart rejection?

There are some things you can do to help reduce the risk of rejection:

• Be sure to go to all your doctor's appointments. These are very important.
• Check your weight, blood pressure, and body temperature regularly. Tell your doctor if you notice any changes.
• Follow a healthy lifestyle. That means eating nutritious foods, exercising regularly, and quitting smoking if you smoke.
• If you experience any unusual symptoms, inform your doctor immediately, without waiting for your next appointment.
• Take all medications prescribed by your doctor exactly as prescribed, at the right time, and in the right dosage. Do not miss a single dose.
• Before taking any new medication (even a vitamin), ask your doctor or pharmacist if it will cause a problem with your anti-rejection medication.

What should I expect if I get rejected?

The risk of heart rejection decreases over time. However, it is important to remember that this can still happen years after surgery.

If you have rejection, your doctor will talk to you about your options. Most people manage this condition with increased doses of immunosuppressants and other treatments. Only 2% to 4% of people who have a heart transplant will need a transplant again.

What questions should I ask my doctor about heart rejection?

You can ask your doctor questions like these:

Before surgery:

• Is this donor's heart a good match for me?
• What should I do to reduce the risk of heart rejection?
• What antirejection medications should I take?
• What are the side effects of those medications?
• How often should I check my weight, blood pressure, and body temperature? What changes should I report to you?

If there is a refusal:

• What type of rejection do I have?
• What kind of treatments can help me?
• Am I eligible for another heart transplant?

Finally, remember this.

Rejection is a common occurrence after a heart transplant. It can occur from a few days after surgery to years later. Therefore, it is important to stay in close contact with your medical team and follow their instructions carefully. Talk openly with your doctor about ways to reduce the risk of rejection and about treatment options. Don't panic, because there are now many advanced ways to manage these conditions. Remember, you are not alone.

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