Late complications following heart transplant

Abstract

Late complications following heart transplantation (HT) have been a significant barrier to improvement in longevity of HT recipients. While improvement in surgical techniques has reduced perioperative morbidity and mortality and adoption of virtual donor-recipient cross-matching and new strategies for identifying and treating the hypersensitized recipients have reduced the incidence of hyperacute rejection, late complications of HT, including allograft rejection and vasculopathy, infection, and malignancy, have remained the major cause of morbidity and mortality among HT recipients (Fig. 31.1). Most late complications following HT are somehow linked to the lack of ideal immunosuppressive balance. Treatment remains rudimentary with little guidance from the literature regarding tailoring therapy except in the case of an adverse event. From this perspective, late complications following HT can be divided into three major categories: In this chapter, we will review common late complications after transplant and their management.