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Heart Transplant Patients' Longer Lives Bring New Challenges

Posted on: Tuesday, 11 January 2005, 21:00 CST

Naperville resident Frank McQuaid owes his heart to a young man from Nebraska.

At age 54, McQuaid had already suffered several heart attacks and often spent weeks in the hospital due to heart failure. It was during one of these stays in 1991 that a nurse ran in and said a donor heart was available.

McQuaid's nine-month wait was over.

"Everyone was smiling except me," he recalled. "My reaction was, thank God, but oh, God. It's what you wanted all this time but now it's really here."

The next morning, doctors told the large crowd of family gathered in the waiting room that the operation succeeded.

McQuaid remains a success story. Thirteen years later, his borrowed heart has let him watch three of his children marry and add five more grandchildren.

The chances of such a long life after transplant are dramatically improved since the 1960s, when the first recipients died within days. Today, half of those who undergo a heart transplant will still be alive 10 years later thanks to better immune suppressant drugs.

But challenges remain. Many of these patients will develop a form of heart disease in their new hearts that is stubbornly resistant to treatment. In others, the effects of the medications keeping them alive prove too much for their bodies to withstand.

Illinois' longest-living survivor is a case in point. Les Brown got his new heart in 1984, the year Loyola University Medical Center opened its heart transplant program.

The immune suppressant drug cyclosporine had just been introduced, for the first time giving doctors hope their patients could have productive lives after transplant. Brown's doctor gave him only a few years to live unless he got a new heart.

"I was worried, but I felt this was the only option available to me, that or pretty sure death," Brown said.

With his new heart, Brown made the next two decades count. As founder of Chicago Coalition for the Homeless, he helped the advocacy group win state money to help families on the verge of losing their homes. He reunited with a daughter, remarried, and welcomed two grandchildren.

A few years ago, he was diagnosed with squamous cell anal cancer, a cancer more common in patients with compromised immune systems. The years of taking immune suppressing drugs had taken their toll.

"I don't think I would have cancer were it not for the transplant," Brown said. "It's an interesting paradox. What saved me is also what's killing me at this point."

Long term, what kills most heart transplant patients is a form of heart failure particular to transplanted organs called cardiac allograft vaculopothy, said Dr. Alain Heroux, co-director of Loyola's heart transplant program.

Sometimes it mimics heart disease in the native heart and can be treated with stents and angioplasty, but in other patients the condition develops soon after transplant and is difficult to treat.

At this point, doctors don't know what causes the disease, but are learning more about the condition's progression through intravascular ultrasound, Heroux said. Some of the risk factors are related to the immune system, so finding better immune suppressant drugs could alleviate the condition.

Researchers already have discovered novel combinations of medication that allow them to prescribe lower doses and still be effective. A greater variety of medications today means doctors can tailor a regimen to the individual patient.

"In the past we didn't have many choices," Heroux said.

"We have more tools to be able to control losing the graft early," Heroux said. "We have more ways to treat patients who have significant rejection. And because we can individualize their immune suppressive regimen today, I believe in the long term it will improve their likelihood of survival, and it will certainly improve their quality of life."

McQuaid rates his quality of life pretty high, though he still must take special care. He takes a handful of pills every day and visits his transplant doctors twice a year.

If he and his wife, Helen, find themselves next to someone coughing at church or the movies, they move to a new seat. Like Brown, McQuaid had cancer - a sarcoma on his hip that was removed and treated with radiation.

But compared to his health before the transplant - when a walk across a parking lot left him winded - McQuaid says the difference is amazing.

"I can walk 18 holes a couple times a week, and to me that's pretty good," he said.

Source: Daily Herald; Arlington Heights, Ill.

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