When is a heart transplant considered for dilated cardiomyopathy?

If damage to the heart from dilated cardiomyopathy is considered to be permanent and unrecoverable, cardiac transplantation may be considered. Dilated cardiomyopathy is a heart condition in which the heart muscle weakens and the heart becomes enlarged. As the heart becomes stretched, its lower chambers (ventricles) are less able to pump blood efficiently, eventually leading to the inability of the heart to pump enough blood to the body, or heart failure, as well as abnormal heart rhythms.

Currently the supply of donor hearts for cardiac transplantation is much smaller than the number of people who might need them. The sickest patients are given the highest priority in receiving a transplanted heart. For many patients, this results in long waiting times for a heart to become available. Many people do not survive during this waiting period. The hearts must be matched to the patient according to blood type and other immune markers. However, for children in early infancy, blood-type matching might not be necessary, since the infant’s immune system may still be immature.

Heart transplantation is not a cure; a lifetime of continuous medical care is necessary due to the possibility of rejection of the transplanted heart. Numerous medications to suppress the immune system are necessary. This immune suppression may allow certain kinds of cancer to become more prevalent or infections to develop. The transplanted heart has a limited lifespan as well, likely due to chronic low-grade attack from the body. Heart disease can be accelerated in transplant patients. Some people whose transplanted hearts have worn out may be able to receive another transplant; however, the lifespan of this heart is typically a fraction of the previously transplanted heart.

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