What To Expect After a Heart Transplant

In the Hospital

The amount of time a heart transplant recipient spends in the hospital will vary with each person. It often involves 1 to 2 weeks in the hospital and 3 months of monitoring by the transplant team at the heart transplant center.

Monitoring may include frequent blood tests, lung function tests, EKGs (electrocardiograms), echocardiograms, and biopsies of the heart tissue.

A heart biopsy is a standard test used to see whether your body is rejecting the new heart. It might be done often in the weeks after a transplant.

During a heart biopsy, a tiny grabbing device is inserted into a vein in the neck or groin (upper thigh). The device is threaded through the vein to the right atrium of the new heart to take a small tissue sample. The tissue sample is checked for signs of rejection.

While in the hospital, your health care team may recommend that you start a cardiac rehabilitation (rehab) program. Cardiac rehab is a medically supervised program that helps improve the health and well-being of people who have heart problems.

Cardiac rehab includes counseling, education, and exercise training to help you recover. Rehab may start with a member of the rehab team helping you sit up in a chair or take a few steps. Over time, you'll increase your activity level.

Watching for Signs of Rejection

The new heart is a “foreign body” that your immune system may attack if you're not getting enough medicine to suppress your immune system after the surgery.

You and the transplant team will work together to protect the new heart by watching for signs of rejection. These signs include:

• Shortness of breath
• Fever
• Fatigue (tiredness)
• Weight gain (retaining fluid in the body)
• Reduced amounts of urine (problems in the kidneys can cause this)

You and the team also will work together to manage the transplant medicines and their side effects, prevent infections, and continue treatment of ongoing medical conditions.

You may be asked to check your temperature, blood pressure, and pulse when you go home.

Preventing Rejection

You'll need to take medicine to suppress your immune system so that it doesn't reject the new heart.

These transplant medicines are called immunosuppressants. They're a combination of medicines that are tailored to your situation. Often, they include cyclosporine, tacrolimus, MMF (mycophenolate mofetil), and steroids such as prednisone.

Your doctors may need to change or adjust your transplant medicines if they aren't working well or if you have too many side effects.

Managing Transplant Medicines and Their Side Effects

You'll have to manage multiple medicines. It's helpful to set up a routine for taking medicines at the same time each day and for refilling prescriptions. It's crucial to never run out of medicine. Always using the same pharmacy may help.

Keep a list of all your medicines with you at all times in case of an accident. When traveling, keep extra doses of medicine with you, not packed in your luggage. Bring your medicines with you to all doctor visits.

Side effects from medicines can be serious. Side effects include risk of infection, diabetes, osteoporosis (thinning of the bones), high blood pressure, kidney disease, and cancer—especially lymphoma and skin cancer.

Discuss any side effects of the medicines with your transplant team. Your doctors may change or adjust your medicines if you're having problems. Make sure your doctors know all of the medicines you're taking.

Preventing Infection

Some transplant medicines can increase your risk of infection. You may be asked to watch for signs of infection, including fever, sore throat, cold sores, and flu-like symptoms.

Signs of possible chest or lung infections could include shortness of breath, cough, and a change in the color of sputum (spit).

The incision (cut) from your surgery must be checked for redness, swelling, or drainage. It's especially important to look for signs of infection because transplant medicines often can mask these signs.

Talk to your doctor about what steps you should take to reduce your risk of infection. For example, your doctor may recommend that you avoid contact with animals or crowds of people in the first few months after your transplant.

Regular dental care also is important. Your doctor may prescribe antibiotics before any dental work to prevent infections.

Pregnancy

Many successful pregnancies have occurred after heart transplant surgeries; however, special care is important. If you've had a heart transplant, talk with your doctor before planning a pregnancy.

Emotional Issues and Support

Having a heart transplant may cause fear, anxiety, and stress. While you're waiting for a heart transplant, you may worry that you won't live long enough to get a new heart. After surgery, you may feel overwhelmed, depressed, or worried about complications.

All of these feelings are normal for someone going through major heart surgery. It's important to talk about how you feel with your health care team. Talking to a professional counselor also can help. If you're feeling very depressed, your health care team or counselor may prescribe medicines to make you feel better.

Support from family and friends also can help relieve stress and anxiety. Let your loved ones know how you feel and what they can do to help you.