Life after transplantation
Heart transplantation is a surgery aimed to remove a damaged or diseased heart and replace it with a healthy donor heart. Most heart transplantations apply to patients in the end-stage of heart failure. Searching for a donor heart is the most time-consuming process. A donor heart must match your tela type to reduce any chance of its rejection. Heart transplantation is used as a saving measure. About 88% of patients survive in the first year after transplantation and 75% - within 5 years. 10-year survival rate is 56%.
Why do we need heart transplantation?
Heart transplantation is required for several reasons. The most common cause is the lack of a full-fledged infarction of ventricular function and the presence of severe heart failure. Ventricular failure develops during congenital heart disease, but what is more often - in congenital defects of a ventricle, or structural abnormalities of a valve. Although, transplantation is life-saving measure, but it has a lot of risks.
What are the risks after heart transplantation?
1. Malfunctions of a donor heart
The most common cause of death in the first month after transplantation is a primary transplant dysfunction, which is accompanied by disruption of a donor heart. Such factors as donor heart injury or narrow blood vessels in patient’s lungs often lead to primary dysfunction.
Rejection of a donor heart
Rejection is the cause of death of patients within the first year after transplantation. The immune system of a recipient receives a new heart as a xenogeneic object and attacks it. Rejection occurs within 6 months after transplantation.
Cardiac allograft vasculopathy
This condition is related to violation of elasticity of coronary arteries walls. They become dense and hard in a new heart. That prevents blood circulation and causes serious damage. Cardiac allograft vasculopathy is one of the causes of heart failure and death in the first years after transplantation. Often it causes heart attacks, dangerous arrhythmias and sudden cardiac arrest.
2. Complications from medications
Taking medicines which block an immune system from attacking a new heart by immune cells causes serious side effects. It can provoke renal irritation. 25% of patients have renal disease occurs in the first year after transplantation.
Infection is the leading cause of hospitalization of patients after a heart transplantation. It also refers to the causes of death within the first year after transplantation. Most often, patients suffer from infectious processes due to receiving immune suppressants.
Suppression of immune system increases the risk of cancer disease and malignant tumors. Malignant processes are one of the causes of death after transplantation.
Living with immunosuppression after organ transplantation
Defenses of your body are always searching for pathogens and other xenogeneic organisms. Unfortunately, it means that your body is not very hospitable host. It tries to heal a transplanted organ that saved your life, just like any other ordinary pathogenic agent. It attacks. Organ rejection is an erroneous attempt of your body to protect you. That is why, there is usage of immunosuppression. Immunosuppressive drugs can block an action of those natural protective forces. Typically, they allow your body to live in harmony with a new organ. But the problem is that by blocking this protection, you become more vulnerable for other infections. This sacrifice is necessary to make in order to perform transplantation. “Living with a transplant is always a balance between rejection and infection”. You should take enough medication to prevent organ rejection. At the same time, you cannot take too many drugs what can increase the risk of infection”. The good news is that presently doctors have made significant progress in maintaining this balance. No, to stay healthy you do not have to live in a sterile bubble. And after the first few weeks or months after transplantation, your life with all that limitations would not be so difficult. “In general, if you maintain a reasonable and fairly healthy lifestyle, you will be fine. What are the precautions I should take after transplantation? Immediately after organ transplantation you are extremely vulnerable. You will be in the phase of induction immunosuppression. You will take fairly high doses of immunosuppressive drugs, thus, taking care of yourself is very important.
You have to:
1. Wash your hands often. Washing your hands is the best method to reduce negative influence of microorganisms. Especially important is doing it before having a meal.
2. Avoid contact with people who are sick. Limit contacts with people who got are with SARS or other infections, such as measles or chicken pox.
3. Avoid people who have been recently vaccinated. Some types of vaccines, like new nasal flu vaccine or measles vaccine, contain live virus in their composition. It can be dangerous for people with weak immune systems.
4. Avoid crowded places. For example, avoid such places as large shopping malls and cinemas.
5. Do not engage in taking care of pets. Pets can carry pathogens; thus, limit your contact with them. You do not have to throw them out. Instead, you should ask your partner or children to fulfill the duties of cleaning mess after your pets and taking care of its hygiene.
6. Do not garden. Some hazardous bacteria live in the soil. So let your garden become wild for a few months. Or ask your children to do weeding instead of you.
7. Brush your teeth every day with a toothbrush and dental floss. This will help protect your mouth from infection. So brush your teeth every day.
8. Do not ignore cuts and scratches. Rinse them and bandage. If you have any signs of infection, immediately contact your doctor.
9. Have safer sex. Sexually transmitted infections, like herpes, can be a problem for anyone. But for a person who has a transplanted organ, they can be really dangerous. Even condoms cannot fully protect you. Colds and viruses can be transmitted even with saliva. Ask your doctor how to stay safe in your case.
Naturally, the specific recommendations depend on your health and your situation. Differences may depend even on a place where you live. If you live in a city, avoiding crowded places is more difficult. Living in countryside is also dangerous, for instance, contacts with cattle or potentially dangerous water. Ask for necessary recommendations your doctor.
Precautions for lifelong after organ transplantation. During the next six months or a year after organ transplantation, a team of doctors who look after your health is likely to reduce the doses of your medications in a “maintenance phase”. You will take the minimum dose. At this time, you can slightly reduce the precautions. You will not be susceptible to infection. But you still have to take the security measures. Wash your hands regularly and limit contact with people who are sick or recently vaccinated.
If you have ever had an episode of organ rejection, your doctor will need to change your medication or increase the dose of immunosuppressive drugs taken by you. This is called immunotherapy against rejection. Whereas your immune system will be depressed, you need to take some additional security measures again. Also, from time to time, your doctor may change some drugs. Some of them may eventually run worse. Additionally, on the pharmaceutical market may appear new, more effective drugs to replace older ones which you are taking.
Receiving your medicine after organ transplantation. All your life after organ transplantation usually means taking a large amount of drugs. Most people daily takes from 6 to 12 different drugs. And there may be more. Receiving such large number of medications may sound intimidating. Some people may be shocked by the number of medicines that they need to take. But you should remember that you were sick before and were on similar drug therapy. Most people actually believe that the drug therapy after transplantation has become less complicated. Receiving your medication is absolutely necessary for you to stay healthy. There are a few tips.
1. Strictly follow your doctor’s advice when it is time of taking medications needed after transplantation.
2. Use weekly or daily pill boxes in order to pre-set the doses of medications and track them.
3. Use an alarm clock, digital clock and timer to help you remember your dose.
4. Ask your family to help you stick to the required schedule of taking medication.
5. Keep your medicine away from children and pets.
6. Keep your medicines in a cool and dry place.
7. Keep a list of all your medicines in a prominent place.
8. If you missed a drug, do not double its dose in the next reception.
9. Keep tracking the amount of medication you have left. Always call the pharmacy to refill it in advance.
10. If it complies with your physician’s recommendations, take your medication with food to prevent adverse effects on gastrointestinal tract.
11. Plan taking your medications in accordance with your daily routine, such as cleaning teeth, lunch or going to bed.
12. Never stop taking medication without the consent of your doctor.
Protection from the side effects of drugs that you receive after transplantation
Drugs taken after transplantation and suppress your immune system are very powerful. Unfortunately, they can damage your body. It means that they affect a whole body, rather than only to suppress immune response to a transplanted organ.
Therefore, the bad news is that you may have adverse reactions to medications. The good news is that similar effects can be overcome.
The specific side effects may be different. It depends on the combination of post-transplant medications taken by you. A general list of side effects that you may have is following:
· nausea and vomiting;
· high blood pressure;
· high cholesterol level;
· face puffiness;
· bones fragility;
· getting weight;
· trouble sleeping;
· temper trantrum;
· swelling and tingling in hands and feet;
· acne and other skin problems;
· hair loss and/ or unwanted hair growth.
Yes, this list is quite long. But, do not worry too much. Not everyone has listed effects or similar. A reaction of one recipient can be completely different from another.
Do not forget that any adverse reactions should be reported to your doctor. Perhaps he or she will be able to change your medication. Or your doctor may find another way to treat these problems. You should not suffer unnecessarily.
Receiving other drugs after transplantation.
In some cases, in order to cope with the side effects you will have to take more drugs. For example, you can take:
1. Antibiotics and antimycotics. They are used to treat infections as a result of suppression of your immune system.
2. Antiulcerous drugs. They are used to treat adverse reactions in gastrointestinal tract.
3. Diuretics. They help to cope with kidney problems or high blood pressure.
During the early stages of treatment, many people are required to take additional medications only. When your doctor decreases your dose of immunosuppressive drugs, the side effects will bother you less or disappear.
Since people who have transplanted organs need to receive such a large number of drugs, they have to be very attentive to the issue of their interaction. Make sure that your doctor knows about all medications which you are taking, including nonprescription drugs or phytopreparations. Even some food products, for example like grapefruit juice, may interact with some drugs.
Life after transplantation:
Safe exercises. Returning to an active lifestyle after transplantation by using exercises and other physical activities, it is normal to worry about damaging their new organ for people underwent transplantation. Physical activity may be seemed as risky. Cycling or roller skating, which you used to do, may be seemed as rash acts now. After all that you have had to endure in order to get an organ for transplantation, the last thing you wanted is to damage it.
“Such caution is a normal reaction, but you are not as vulnerable as you think. Physical activity is usually not dangerous for people who have transplanted organs. Often this is a key factor to maintaining health. Exercise helps people who have got a transplant, as well as everyone else. Physical activities are lower your blood pressure, help your heart and reduce your weight. Exercises also help you sleep well and relax. And, by doing exercises, you simply feel better. How long does it take to return to normal exercise tolerance? Of course, you cannot immediately return to a tennis court. However, recovery period after transplantation generally does not take longer than other types of surgical interventions. Recovery may be a bit slow because of the drugs that you need to take in order to prevent organ rejection. After staying in a hospital for about a week or longer in case of heart or lung transplant most people can go home. Within a few weeks, you have to be sparing of yourself.
For a month approximately, generally people return to their normal activity level, for instance, driving a car. If there are no complications, then after two or three months, they are usually fully return to normal life.
The statement that people who underwent transplantation are sick or weak is absolutely wrong. Instead, you can feel more energy than you have had for a long time before.
Successful transplantation usually allows people to increase their exercise tolerance. In order to prove it, there are many good examples. For instance, Chris Klug is a liver transplant recipient who was able to win the bronze medal in snowboarding at the Winter Olympics in 2002. Also, an excellent example can be a basketball player Sean Elliott who is a former player of San Antonio Spurs. He returned to the NBA in seven months after kidney transplantation.
Physical activity advices
1. Ask your doctor for advice before starting any of fitness programs. This advice applies to all who have received a transplant. And especially for those who prefers rough and traumatic sports, like football, or high load level, like jogging.
2. Engage in what activities which you really like. This is natural, but better to repeat once more again: if you do not choose a sport that you enjoy, you would not deal with it. So, do be rush choosing your sport activity. Try different options.
3. Be careful with swimming. Public swimming pools and bays can contain dangerous bacteria. Consult with your physician before you go there.
4. Set a realistic goal. You should not try to run a marathon immediately. Take your time. Start slowly and gradually increase load level. Eventually, try to reach a little bit higher level of physical activity every day.
5. Do not put pressure on yourself. Listen to your body. If you feel pain doing exercise or severe fatigue, it means that you overloaded yourself. Next time you should not to force yourself that much.
6. Do not do it only by yourself. It is recommended to do physical activity together with other people. Try to walk or cycle with a friend. Try to attend fitness classes. Doing activities together with other people can make a lots of fun. It also increases your commitment to exercises, because someone else will count on you.
7. Make some minor changes. Little things bring difference. We recommend you to force yourself to walk whenever it is possible. Reject your newspaper subscription; instead, you can walk to the store on a corner to get it. Or get a dog, which you have to take for a walk.