Heart-lung transplant - Risks of a heart-lung transplant

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

There are two types of rejection:

acute rejection – where rejection occurs just after surgery
chronic rejection – where rejection occurs many months or years after surgery

Signs that your body may be rejecting your heart include:

fatigue (extreme tiredness)
swelling of your arms and legs
weight gain
a high temperature (fever) of 38°C (100.4°F) or above

Signs that your body may be rejecting your lungs include:

coughing
shortness of breath
breathing difficulties
a high temperature (fever) of 38°C (100.4°F) or above
swelling of your arms and legs
weight gain
heart palpitations (heartbeats that become more noticeable)

If you have any of these symptoms, you should contact your transplant centre as soon as possible. Rejection can usually be treated by increasing your dose of immunosuppressant medication.

Infection

Immunosuppressant medication will weaken your immune system and make you more vulnerable to infection. The three most common types of infection that affect people who have had heart-lung transplants are:

bacterial infection
fungal infection
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 38°C (100.4°F) or above
feeling generally unwell
sweating and shivering
loss of appetite
pain in your chest

If you think that you may have pneumonia, you should contact your GP or your transplant team. The condition will need to be treated with antibiotics.

To help prevent infection, you may also be given antibiotics to take for the first few weeks after your transplant.

Fungal infections

Fungal infections are not as common as bacterial infections, but they can also sometimes develop in the first few weeks after having a transplant.

Less serious fungal infections can develop in the skin, nails, mouth, feet and 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
a discharge of a thick white fluid from the vagina (in cases of vaginal infection)

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

Symptoms of an invasive fungal infection include:

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

You should contact your transplant centre as soon as possible if you think that you may have an invasive fungal infection.

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 antifungal 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.

Cytomegalovirus infection

Cytomegalovirus (CMV) infections are less common because of the introduction of antiviral treatment. It usually occurs after stopping this treatment between 6-12 months after the transplant.

Symptoms of a CMV infection include:

a high temperature (fever) of 38°C (100.4°F) or above
shortness of breath
the appearance of large, painful ulcers in your mouth
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 transplant centre as soon as possible.

CMV infections can be treated with antiviral medication.

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

Read more about treating cytomegalovirus infections.

Preventing long-term infection

After having a heart-lung transplant, it is likely you will need to take immunosuppressants for the rest of your life because you will be more vulnerable to infection. This means you will have to take extra precautions, including:

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
keeping your house very clean to prevent the spread of infection

Read more about how to prevent germs spreading.