13 January 2009

After the heart transplant

The amount of time a heart-transplant recipient spends in the hospital will vary with each person. Importantly, you will need to take medicine to suppress your immune system.

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 centre. Monitoring may include frequent blood tests, pulmonary (lung) function tests, ECGs (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 frequently in the weeks after a transplant. During a heart biopsy, a tiny grabbing device is inserted into a vein of 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.

Watching for signs of rejection

The new heart is a "foreign body", which your immune system may attack if you're not receiving enough medicine to suppress your immune system after the surgery. Therefore, 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 monitor your temperature, blood pressure and pulse when you go home.

Preventing rejection

You will need to take medicine to suppress your immune system so that the new heart will not be rejected. 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.

Transplant medicines may need to be switched or adjusted if they aren't effective or have too many side effects.

Managing transplant medicines and their side effects

You will have to manage multiple medicines. Setting up a routine for taking medicine at the same time each day and for refilling prescriptions is helpful. It's crucial to never run out of medicine. It may help to always use the same pharmacy.

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

Side effects from medicines can be serious. These 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, because the dose of a given medicine or the medicine itself can be changed. Report all new medicines to your transplant coordinator.

Preventing infection

Some transplant medicines can increase your chances of developing infections. 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 colour of sputum (spit).

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

Discuss with your doctor measures you should take to reduce your chances of developing infections. 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.


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

Emotional issues

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 counsellor also can help. If you're feeling very depressed, your health-care team or counsellor 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.

Source: US National Institutes of Health: Heart, Lung and Blood Institute



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