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Any medical types on the flist...
So, I have a couple of questions for a fic and I'm sure I could google or wiki it but...
- What kind of complications could arise from a heart transplant?
- What are the considerations? Do blood types have to match etc...?
- What's the recovery like?
Basically I'm going to be using "science-fiction" rather than science - alien technology, but there are some things that would still work the same...
This is for my second sweet charity fic so any help would be appreciated... I've completely changed what I'm writing... again... *bites fingernails*
- What kind of complications could arise from a heart transplant?
- What are the considerations? Do blood types have to match etc...?
- What's the recovery like?
Basically I'm going to be using "science-fiction" rather than science - alien technology, but there are some things that would still work the same...
This is for my second sweet charity fic so any help would be appreciated... I've completely changed what I'm writing... again... *bites fingernails*
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Sorry I can't be of more help. Are you sure you don't have any questions about theology or the Australian legal system?
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There's SO much more to this, I'm not even gonna start writing it here, but you can check this site:
http://www.nlm.nih.gov/medlineplus/encyclopedia.html
Or more specifically, this: http://www.nlm.nih.gov/medlineplus/ency/article/003003.htm
Hope that helps.
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As far as complications, the major one will be host versus graft disease for a heart transplant (the opposite, GVD, is more likely with bone marrow or liver transplants). Any amount of inflammation around the heart is going to do two things - decrease efficiency of pumping and also negatively impact breathing because the space around the heart (the pericardium) will get flooded with fluid and start pressing on the heart and lungs. Inflammation in these areas also lead to pneumonia frequently. The symptoms will be much like what the person had prior to the transplant - congestive heart failure. Additionally, the amount of inflammation will increase the risk for stroke due to immune cells clotting in places. The damage from inflammation from the rejection will also lead to severe hardening of the arteries around the heart.
Recovery -- Major heart surgery is a bitch to recover from. First, there's the fact that the ribs have been cracked -- doing this and the resulting trauma inside the chest cavity make it a priority to recover the patient's breathing. The surgery causes the lungs to pull up and also negatively impacts the diaphram. So breathing therapy to regain lung volume is the first and longest process. It also hurts horribly from people I know that have had chest surgery. Second, anyone far enough along to have a heart transplant is going to need basic therapy as well - as congestive heart failure and similar causes proceed, the person can do less and less due to the poor circulation and so will generally be in pretty poor condition muscular wise and all. They will FEEL a hundred times better thanks to the improved blood flow, but they'll still be very weak.
I think those are the basics. You can email me if you have more questions (not a MD doctor, but almost went that way and still am resposible for translating the medicine for all of my family and friends).
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Activity Level
Your heart reacts differently to stress now. The nerves that connected your original heart to your nervous system were cut during the transplant surgery and do not heal. That means your heart cannot respond immediately to exercise, sudden movement, or emotional stress like fear. It does react, but not nearly as fast. Now, it increases its rate in response to hormones in your blood.
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a) infection
b) bleeding
c) anaesthetic risks
i)airway difficulties which range from getting your teeth chipped to not being able to get an airway and killing the patient
ii) anaphylaxis to the drugs used
iii) depression of respiration due to the drugs used
iv) cardiac arrest due to the drugs used.
Specific to cardiac transplantation:
a) cardiac arrest (you take out the heart, you put the new one in, and it don't start/ you start to take the old one out and it gives up the goat before you get there - generally people who get a transplant have been on the list a LONG time and are pretty sick by the time they get the transplant)
b) complications from being on cardiac bypass which involves a degree of hypoxia. Leave someone on too long and you ruin their brain.
c) INFECTION - in order to not reject a transplant you have to have your own immune system suppressed for the rest of your life.
d)Rejection. Which if it happens early is devastating.
there's more than that but this isn't really my field.
Tissue matching is not based on blood type. It is based on HLA typing (blood typing is important for blood transfusions :D).
HLA = Human leucocyte antigens. These are little complexes that we all have sitting on the outside of our cells. Basically they operate to provide us with immunity. If a virus gets into your cell, or cancer, or something else that shouldn't be there the cell alerts your immune system by displaying it in a HLA. THe immune system can then act by destroying the cell or creating antibodies against the foreign agent. There's great variety amongst HLA types for the obvious reason that good varied immmunity allows greater resistance for the human race against new and improved viruses.
Unfortunately because the immune system is designed to contact these HLAs, if they see a HLA they aren't used to (i.e in donated tissue) they'll be primed to make antibodies. Which is why its so important to get a match.
There are three types of HLAs on chromosome 6. Because you get two different ones from your mum and Dad, you have six different HLAs. THe interesting thing about them is that they are inherited as a 'haplotype' so the three that sit on the one chromosome will all be passed down as a group together. So in theory three of your HLAs will also be found in your mother, and in one of her parents. (or your father etc.) That means that siblings are usually uniquely placed to be good donors. (Unless you are vastly unlucky and they got the exact opposite chromosomes to you).
I'm not up with the latest research, but last I heard there was some studies now saying that with good immunosuppression you might be able to match donors with only 5/6 match.
But yeah, even with a 6/6 match, our testing methods aren't as good as mother natures and the immune system will eventually detect that the tissue is slightly foreign and therefore must be destroyed.
Which brings me to the issue of recovery. People with donated organs generally do brilliantly immediately post surgery. They look and feel awesome. Mostly because like I said before, by the time they get to surgery, because the transplant lists are so damn long, they're generally pretty sick. And then they get a new organ that actually works, and its frikking amazing.
Unfortunately, mother nature is always going to kick our arses. The thing with foreign donations is that graft rejection is not something that might happen. It WILL happen eventually. Everything we do is just an attempt to stave it off.
You may be interested to know that the five year survival post-transplant is between 60 and 70%. Most people don't get longer than aout 15 years. (I think the record is 29).
There you go. Hope that helps :D
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The body will attack anything that’s not its own. When someone is given a donor organ, the cells of the immune system realise that it is foreign and attack it. When the immune cells attack a new organ there’s the risk of rejection so there’s a need for anti-rejection medication. Rejection is most common in the first six weeks but can occur at any time. The dosage of anti-rejection medication is usually decreased over time but transplant patients remain on anti-rejection medication for the rest of their life.
Regular heart biopses will also be performed to check for any signs of rejection.
The anti-rejection medications used to suppress the immune system can cause diabetes. If someone had diabetes before the transplant, the control of blood sugar may be more difficult and will be monitiored strictly. Medication can also cause blood cholesterol to go up and will also be monitored.
Infection is also a risk because the anti-rejection drugs that prevent immune cells from attacking and killing new organs are immunosuppressive drugs which also prevent immune cells from attacking other foreign objects in the body. Because they block the ability of immune cells to attack foreign objects in the body the drugs cause a risk of developing infections caused by foreign bodies like viruses and bacteria.
Infection is more a risk if someone is being medicated with a high dose of immunosuppressive drugs. Someone will be on high doses of the drugs immediately after transplant surgery and during times of rejection. As the doses of immunosuppressive drugs are lowered the chances of getting an infection are also lowered but the risk never goes away.
Blood pressure should also be monitored after transplant as it is often a common problem and left unchecked could cause kindney problems, stroke and ultimately a heart attack.
There is also a risk of mood swings due to the high doses of steroids used in the early days after the transplant.
Considerations:
For blood transfusions a person need only match ABO type and Rh type. (blood type, like A-positive.)
For organs a much more strict match is needed. Blood will only be there for a few weeks; the organ will be there for the rest of your life. For that, every attempt to match the Major Histocompatibility Complex (MHC) which is basically a cluster of genes essential to the immune system. Tests will be conducted to obtain a close match as the body will be very allergic to the proteins produced by somebody else’s MHC, and the body will attack what it sees as a foreign object.
Also, the heart of the donor, where possible is preferred to be close enough to the recipient’s heart's size, so the donor is preferred to be within 20 percent of the weight of the recipient.
Recovery:
Recovery is usually around six weeks taking into account that there were no complications during or post surgery, longer than other serious operations due to the immune system being suppressed but most people are usually released from the hospital within ten to fifteen days.
The first year is considered critical with frequent scheduled heart tests (endomyocardial biopsies) performed to watch for early signs of organ rejection and usually a cardiac rehabilitation program will have been instituted during the hospital stay which will continue upon discharge including supervised physiotherapy. Within a few weeks of the operation most people will be able to do quite vigorous exercise. The rehabilitation programme also offers advice about how to have a healthier lifestyle, and psychological support for patient and partner.
Regular exercise is encouraged, always started with warm up period as new hearts respond slowly to the demand of exercise as it is without nerve supply in the first year but most people are soon able to take in part in a full range of activities and exercise.
Quality of life is usually good, especially if the side effects of the immunosuppressant drugs can be kept to a minimum. People are able to return to work, education and many heart transplant patients have no major problems with sporting activities.
Usually within six to eight weeks after the operation life pretty much returns to something like normal.
Hope that helps a little :)
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