Strong Heart and Vascular Center

Transplant

Rejection

Rejection occurs when your immune system identifies your new heart as foreign tissue and mounts an attack against it. A variety of specialized cells are sent to the new heart in an effort to protect the body from this foreign invader.

Rejection occurs most frequently during the first six months following transplantation. During this time, the immune system attempts to mount an attack against the foreign organ. High dose immunosuppression is necessary in these early months to prevent organ damage from the immune system.

As time passes, the immune system, under the constant restraint of immunosuppressive medication, becomes less aggressive in its rejection response. Even though there is a diminished response, rejection can occur at any time and immunosuppressant medications are required for life.

The immunosuppressive medications decrease the immune response; however, virtually all patients will experience rejection at some point after their transplant.

Symptoms of Rejection

In most cases, rejection does not cause any signs or symptoms. In more advanced stages, symptoms are similar to those of heart failure. Symptoms of rejection include:

• Shortness of breath
• Irregular pulse
• Edema
• Unusual fatigue
• Unexplained weight gain over one to three days
• Low blood pressure
• Low grade fever

Remember: Most patients experiencing rejection will have no symptoms. However, if symptoms occur, please call your transplant coordinator.

Monitoring

Because rejection may occur without any symptoms, all patients undergo routine surveillance biopsies to help the transplant team determine whether patients are experiencing rejection. After transplant, routine biopsies are performed weekly for the first four weeks, biweekly during the second month and then monthly for the remainder of the first year. If rejection is identified, patients are treated with additional immunosuppression, and a repeat biopsy is performed one to three weeks after the rejection is treated.