Organ rejection is a major risk with any organ transplant. Patients will require life-long immunosuppression to reduce the risk of transplant rejection.

Immunosuppressants have a long list of complications, particularly:

• Side effects of steroids (e.g., diabetes, osteoporosis and Cushing’s syndrome)
• Severe or unusual infections
• Skin cancer
• Post-transplant lymphoproliferative disorder (a form of non-Hodgkins lymphoma)

A key complication after a heart transplant is cardiac allograft vasculopathy (CAV), which involves narrowing of the coronary arteries in the donor heart. The donor heart is not innervated, meaning the patient will experience symptoms of ischaemia in the heart tissue. This means they will not have any symptoms of angina or myocardial infarction. Patients have regular follow up coronary angiograms to monitor for this.

The key complications after a lung transplant are:

• Primary graft dysfunction (PGD), which usually occurs within 3 days, with acute pulmonary oedema, alveolar damage and hypoxia
• Bronchiolitis obliterans syndrome (BOS), which usually occurs within 1 year, with damage to the bronchioles
• Dehiscence of the bronchial anastomosis, which causes air leakage into the mediastinum and is life-threatening

Survival is approximately:

• 85% at 1 year for heart or lung transplants
• 75% for heart transplants at 5 years
• 50% for lung transplants at 5 years