Heart Recovery

After a heart transplant, when you leave the hospital, you will be given a supply of medications, instructions on how to care for yourself, and phone numbers to call with questions or for emergencies. You will need to come back to the Yale-New Haven Transplantation Center periodically to assess your recovery. You will require routine surveillance right heart catheterizations and heart biopsies to rule out rejection for the first year, along with routine blood work and clinic visits.

You will have a number of medications to take after your transplant. Gradually this number can be decreased so that you may need to take only your anti-rejection medication for the rest of your life. Tell us about any side effects you may experience; in most cases, side effects from medication can be successfully managed.

The most common complications of heart transplant surgery are infection and rejection. Anti-rejection (immunosuppressant) drug levels are monitored closely and adjusted to levels which prevent rejection while allowing the transplant recipient the ability to fight infections.

Despite careful monitoring and adjustment of medications, rejection may occur, and is detected most commonly in the first six months following surgery. During this time period, biopsies are being performed frequently and doctors are able to diagnose and treat it immediately, when it responds readily to treatment. Rejection is normally treated with combinations of immunosuppressive drugs given in higher doses than maintenance immunosuppression. Most rejection episodes are successively treated without lasting effects.

Infection can result from surgery, but most infections are a side effect of the immunosuppressive drugs given to prevent rejection, which interfere with a person’s natural immune system. While these medications are important and keep the immune system from attacking the donor heart, they may put the individual at risk for infections. Drug levels will be closely monitored and dosage adjusted as needed. Antibiotics are given during surgery to minimize the risk of bacterial infections. In addition, antiviral drugs are given in the first months following transplant to help prevent certain viral infections which are of particular risk to the transplant recipient. Patients are closely monitored for infections. If detected, infections are treated with antibiotics or other drugs, depending upon the type of infection.

Here are some things you can do to protect yourself from infection after surgery:

• Wash your hands often, especially after coughing or sneezing, and keep them away from your face and mouth.
• Stay away from people who have a cold. If someone in your household gets sick, have that person use separate towels and kitchen utensils, cover their mouth when coughing or sneezing, and wash their hands often.
• If you have a wound and have to change your own dressing, wash your hands before and after. Don’t work in the soil for six months after your transplant, and after that wear gloves. Don’t handle animal waste and avoid contact with animals who roam outside. If you have a cat litter box, it should be covered and taken out of the home before it is changed.

Contact your doctor right away if you experience any of the following:

• New onset of palpitations
• A fever or temperature equal to or greater than 100 degrees F.
• Unexplained or unexpected shortness of breath
• Unusual weakness, fatigue, or dizziness
• Unexplained weight gain of three pounds or more over 1-2 days
• Excessive ankle swelling
• Any enlarged lymph nodes or unexplained lumps in the groin or armpits
• A cough that lasts more than a week or which produces a yellowish substance
• Pain, discharge, or significant swelling at the site of your surgery
• An inability to take your medication
• Bleeding from the rectum or excessive bleeding from a cut
• Failure of a cut or bruise to heal
• A rash or other skin changes
• Exposure to a communicable disease such as measles or chicken pox

We will provide plenty of medical and emotional support after your transplant, but much of your success will depend on you. Caring for yourself after a transplant involves taking anti-rejection medication as instructed, watching for early warning signs of a potential problem, and staying as healthy as possible.