After the heart transplant surgery, the usual time in the ICU is one to three days and then four to 10 days on the transplant floor. The sicker and weaker you are going into to the surgery, the longer it will take to recover after the surgery, and some patients require a rehab facility afterwards for further strengthening. During this time you will be closely monitored and educated as to the new medications and possible issues you may be facing after the transplant. You will receive a post heart transplant manual after your surgery.
Immediately after your heart transplant operation, you'll be started on special medications to maximize the survival benefit of the transplant. These are on top of the other medicines you have been taking for your non-cardiac conditions. Over the first year, your transplant team may adjust several of the medicines. You'll be weaned down or off some, and others may be increased.
- Immunosuppressants – These medications are to help prevent a heart transplant rejection by suppressing your body's natural immune responses.
- Antibiotics, antivirals, antifungals – These medications are to assist in preventing infections that you are more prone to since your immune system is weakened.
- Vitamins, minerals - These medications help the body in the healing process and maintaining good health.
- Cholesterol medications – These medications help prevent the development of coronary artery disease in your new heart.
- Blood pressure medications – Most transplant recipients develop hypertension and thus require blood pressure medicines.
After your discharge, you will be closely monitored by the entire transplant team, which includes the transplant cardiologist, advanced care practice nurses and coordinators. You will be given a specific schedule of visits, which will include blood work, chest X-rays, clinic exams and heart biopsies. The transplant team will send updates to your referring cardiologist and primary care physician. All of your medical care the first year will be under the transplant team.
After the first year, all of your primary care will be returned to your primary care physician and you will see the transplant team less frequently. However, you will see the transplant team for your entire life with biannual checkups to monitor for any complications associated with life-long immunosuppression or heart transplant rejection.
Common Problems after Transplant
- Medication side effects – There is a long list of potential side effects from all of the medicines. The most common include tremors, insomnia, nausea and high blood pressure.
- Heart Transplant Rejection – This occurs when your immune system reacts to your heart and tries to damage it. We are in constant surveillance of this problem with biopsies and specialized blood tests, so that most of the time, we find early rejection before symptoms develop or damage occurs. This is why staying with your follow-up schedule is so important. If a rejection is detected, your oral immunosuppression meds may be adjusted or you may receive IV steroids. This is most likely to occur in the first year.
- Infections – Because your immune system is suppressed, infections are a real risk. Some medications are given to prevent infections. Other times, we watch for early signs of infection and treat at that time. The greatest danger for this is the early months after your heart transplant surgery when your immune suppression meds are at their highest doses.
Returning to Work
The appropriate time to return to work depends on several factors - how ill you were prior to your heart transplant surgery, how long it takes you to recover after the surgery and what type of work you are doing. Once your incisions heal and you are feeling well, you will discuss this timing with your transplant team. Some are able to return to work in a matter of weeks, others could be months.
Your team wants you to return to work as soon as it is safe to do so. If you were on cardiac disability at the time of your heart transplant operation, this will remain in effect until one year after the transplant. After the one year, cardiac disability is no longer in effect and you could lose those benefits.