Heart Transplant Test & Procedure in India

Overview:

A heart transplant is a surgical procedure recommended for people whose heart fails to function sufficiently and is replaced with a healthy heart from a donor. The procedure is considered a last resort when medications and other surgeries have not worked to revive the functioning of the heart.

The transplant is done when a person has a weakening heart, a coronary arterial disease, a congenital heart disease (defect from birth) irregular and dangerous heartbeats or rhythms, and if a person has had a previously failed heart transplant. There are many factors to be considered if a person is eligible for a heart transplant like an advanced age that interferes with the recovering ability of a person, certain medical conditions, infections, cancer, and inability to make lifestyle modifications. 

Once a person is considered eligible for a heart transplant, they need to undergo certain vital tests to determine if they are physically fit to receive a transplant. This involves assessing the health of organs that may increase the risk of a transplant. 

Doctors perform these tests so that the efforts of a heart transplant which is a very intricate and complicated procedure are not in vain.

Tests Done Before A Heart Transplant:

• Blood test: A blood test is carried out to find out the blood group of the person to find a suitable donor that has the same blood group. The four blood groups that humans have are A, AB, B, and O.

The test is a basic and simple blood test that involves drawing blood and sending it to the laboratory for testing. The tissue type of the person is tested to determine if there are any antibodies in their blood against the other tissue types. If the antibodies are detected then the donors who would react to those antibodies, are avoided. This however reduces the likelihood of finding a suitable donor. The blood test is also conducted to find out if there is any infection present in the person’s body like Hepatitis B or C, HIV etc.

• Antibody tests: Antibodies can be formed in a person’s body if they have had a blood transfusion or any other transplant. The test helps to identify the presence of antibodies that may react with the donor’s tissues. Once the antibodies are formulated in a person’s body it is very difficult to remove them and they can affect the success of the heart transplant surgery.
• Heart tests: Various heart tests are conducted before the transplant. They include:

1. Twelve lead ECG (electrocardiogram)
2. A heart scan called the echocardiogram.
3. A stress test which includes an exercise ECG or myocardial perfusion scan.
4. Cardiopulmonary exercise testing.
5. Right heart catheterization which determines if the transplanted heart will work well with the person's circulation system and the extent of damage to the heart. The procedure involves putting a tube in the vein of the neck and through this tube, a catheter is put in the right side chamber of the heart and the arteries. The process takes place in half an hour to check the functionality and the output of the heart. Anesthesia is given to the person before the procedure.

• Lung tests: The lung tests conducted before the transplant include, the lung function test also called spirometry, and chest X-rays.
• Scanning: The person may require a CT scan to evaluate the health of their abdominal organs and lungs before they undergo a heart transplant.
• Other special tests: The person is required to undergo other tests such as 
  1. To check their height and weight for their body mass index (BMI) calculation.
  2. They need to give bacterial swabs for Methicillin-resistant Staphylococcus aureus (MRSA) infection in the body.
  3. If the person is older they must undergo the DEXA test for their bone density.
• Psychological evaluation:  Before going for a heart transplant a person is also required to visit a psychologist or a psychiatrist. The health professional assesses the mental fitness of the person in terms of their ability for post-transplant care. This includes taking medication on time and making and adhering to lifestyle modifications for the rest of their lives. 

Tests Required After A Heart Transplant:

After receiving a heart transplant a person is required to take multiple tests to check if the heart is functioning well after the procedure and how the medicines are affecting the person’s body.

The doctor recommends the following tests:

• A complete blood count test: The test measures the levels of the red blood, white blood cells, and platelets.  This test helps to find if the person is anemic, has any infections, and if the bone marrow is influenced by the immunosuppressants taken by the person or the infection.
• Comprehensive metabolic panel test: This test measures various components in the blood of a person who has had a heart transplant to give valuable information on the metabolism and the chemical balance of the body. The components include glucose, electrolytes, proteins, enzymes, bilirubin, blood urea nitrogen, and creatinine.
• Infection test: The test checks for a certain virus called the cytomegalovirus that leads to common cold in a person and can cause multiple complications in the body of a person who has had a heart transplant.
• Natriuretic peptide test: This test helps detect a hormone that is released in the body due to changes in pressure inside the heat. These pressure changes help determine heart failure and other cardiac issues.
• Test for immunosuppressant levels: Immunosuppressants act on the immune system of the person and reduce the risk of the body rejecting the new heart. If the levels of immunosuppressants go below a certain level in the body the new heart stands a greater risk of being rejected.  
• Antibody test: The body can develop certain antibodies against the new heart. The test helps to check the development of antibodies. This monitoring is crucial because if the person begins to develop antibodies that are specifically against the heart, the person may have a possibility of antibody-mediated rejection. 
• AlloMap Heart test: The test checks the levels of genes in the person’s body. Low levels indicate that there is a lower risk of the rejection of the heart.
• AlloSure Heart test: This test measures the level of a specific biomarker in the blood of the person. The biomarker is called the donor-derived cell-free DNA (dd-cfDNA). When the levels of this biomarker increase in the blood it means there could be some problem with the heart.

Conclusion:

A heart transplant is a very complicated procedure that requires a tremendous amount of expertise, effort, and care by doctors. Finding a suitable donor is a challenging task considering various factors that can cause the new heart rejected by the person’s body. Hence it is important to assess the person’s health through multiple tests that help the transplant team determine the eligibility of the person for the procedure. After the transplant care is equally important to check if the person’s body has accepted the heart and the organ is functioning well.

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