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Heart lung transplant - Disadvantages of a heart-lung transplant

NHS Choices Medical Reference

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One of the biggest risks after having a heart-lung transplant is that, despite taking immunosuppressants, your body will reject the new heart and lungs.

There are two types of rejection:

  • acute rejection - where rejection occurs just after surgery, and
  • chronic rejection - where rejection occurs many months, or years, after surgery.

Signs that your body may be rejecting your heart include:

  • fatigue,
  • swelling of your arms and legs,
  • weight gain, and
  • a high temperature (fever) of above 38C (100.4F).

Signs that your body may be rejecting your lungs include:

  • cough,
  • shortness of breath,
  • difficulties breathing, and
  • a high temperature (fever) of above 38C (100.4F).

If you have any of these symptoms, you should contact your GP and/or your transplant centre as soon as possible.

Rejection can usually be treated by increasing the dose of your immunosuppressive medicines.

Infection

The immunosuppressants medicines will weaken your immune system making you more vulnerable to infection.

The three most common types of infection experienced by people who have undergone heart-lung transplants are:

  • bacterial infection,
  • fungal infections, and
  • cytomegalovirus (CMV) infection.

CMV is a common virus that is part of the herpes family of viruses.

Bacterial infection

A bacterial infection of the lungs (pneumonia) is common in the first few weeks after a transplant.

Symptoms of pneumonia include:

  • breathing difficulties.
  • coughing up phlegm (thick mucus) that may be yellow, green, brown, or blood-stained,
  • wheezing,
  • a rapid heartbeat (tachycardia),
  • a high temperature (fever) of above 38C (100.4F),
  • feeling generally unwell,
  • sweating and shivering,
  • loss of appetite, and
  • pain in your chest.

If you think that you have pneumonia, you should contact your GP and your transplant team. If you have got pneumonia, the condition will need to be treated with antibiotics.

You may also be given antibiotics to take for the first few weeks after your transplant as a precaution against infection.

Fungal infections

Although not as common as bacterial infections, fungal infections can also develop in the first few weeks after a transplant.

Less serious fungal infections can develop in the skin, nails, mouth, feet and, in women, the vagina.

The symptoms of these types of fungal infection will depend on what part of your body is affected, although shared symptoms include:

  • scaling and redness of the skin,
  • itchiness, and, in cases of vaginal infection,
  • a discharge of a  thick white fluid from the vagina.

More serious fungal infections can develop inside the body (invasive fungal infections), such as in the lungs (fungal pneumonia), or in the blood stream.

Symptoms of an invasive fungal infection include:

  • a high temperature (fever) of above 38C (100.4F),
  • shortness of breath,
  • dizziness,
  • chest pain, and
  • a change in mental behaviour, such as confusion or disorientation.

If you think that you may have an invasive fungal infection, you should contact your GP and/or transplant centre as soon as possible.

Non-invasive fungal infections can be treated using antifungal creams and tablets. Invasive fungal infections may require admission to hospital and treatment with injections of anti-fungal medication (intravenous antifungals).

As a precaution against fungal infections, you may be given a course of antifungal medication to take for several months after your transplant.

CMV infection

CMV infections are common during the second month after a transplant.

Symptoms of a CMV infection include:

  • a high temperature (fever) of above 38C (100.4F),
  • shortness of breath,
  • the appearance of large, painful ulcers in your mouth, and
  • visual disturbances, such as blind spots, blurring, and floaters (tiny black, or shadowy, dots, or lines, that appear to be floating in your field of vision).

If you think that you have a CMV infection, you should contact your GP and/or transplant centre as soon as possible.

CMV infections can be treated with anti-viral medicines.

As a precaution against CMV, you may be given a course of anti-viral medication to take for several months after your transplant.

Preventing long-term infection

After having a heart-lung transplant it is likely that you will need to take immunosuppressants for the rest of your life because you will be more vulnerable to infection. This means that you will have to take extra precautions that most people are not required to take. These include:

  • avoiding crowds - if this is unavoidable you should wear a face mask, particularly during the first year after your transplant,
  • avoiding close contact with anyone who is known to have an infection,
  • avoiding anything that could damage your lungs and make them more vulnerable to infection, such as smoke, chemical sprays, or chemical fumes, and
  • keeping your house very clean to prevent the spread of infection.
Medical Review: July 11, 2009
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