After a heart transplant, your body may see the donor heart as a foreign object and attack it. Heart transplant rejection can happen days, weeks, months or years after surgery, even with immunosuppressant drugs. Treatment options include changing antirejection medications or repeating the transplant with a new donor heart.
A heart transplant is a treatment for end-stage heart failure. It’s an option if you have symptoms of heart failure despite optimal treatment with medications and medical devices. During a heart transplant, a surgeon removes your heart and replaces it with a heart from a donor who has died.
Your body may see the donor heart as a foreign object and attack it. This is called heart transplant rejection. Rejection is most common in the first several weeks after transplantation, but it can happen months or years later.
Rejection can lead to complications, such as:
Before a heart transplant, you’ll take immunosuppressant medications. These try to control your immune system so it doesn’t attack the new organ. But immunosuppressants don’t always prevent rejection.
There are three main types of heart transplant rejection:
Heart transplant rejection is common among people who’ve received transplantation, even in those who take all their immunosuppressant medications. But it’s becoming less common over time as scientists learn more about immunosuppression.
Certain factors can increase the risk of rejection, including:
Heart transplant rejection happens when your immune system recognizes a donor heart as a foreign object. It sends T cells or antibodies to attack the invader.
This can occur even with antirejection drugs for heart transplant patients. Scientists don’t fully understand why it happens.
Heart transplant rejection can occur with no symptoms at all. That’s why it’s important to attend all of your follow-up tests so your healthcare provider can screen for problems. But some recipients do experience symptoms.
Signs of heart transplant rejection may include flu-like symptoms, such as:
Other possible heart transplant rejection symptoms include:
After heart transplantation, you’ll have regular checkups to monitor for rejection. Your healthcare providers may order certain tests, such as:
Treatment for heart transplant rejection depends on many factors, including:
If you experience heart transplant rejection, your healthcare providers may:
Certain strategies may help you prevent heart transplant rejection:
The chances of heart transplant rejection decrease over time, but it can occur years after surgery.
If you experience heart transplant rejection, your healthcare provider will talk to you about your options. Many people can manage the condition with increased immunosuppressants and other treatments. About 2% to 4% of people who’ve had a heart transplant receive a repeat transplant.
Consider asking your healthcare provider the following questions about heart transplant rejection.
If you experience rejection:
A note from Cleveland Clinic
Organ rejection is common after heart transplant surgery. It can occur days to years after transplantation. Talk to your healthcare provider about ways to decrease rejection risk and possible treatment options.
Last reviewed by a Cleveland Clinic medical professional on 05/16/2022.
Learn more about our editorial process.