After Transplant



Staying in the Hospital

The amount of time a heart and lung transplant recipient spends in the hospital varies. Recovery often involves 1 to 2 weeks in the hospital and 3 months of monitoring by the transplant team at the heart and lung transplant hospital.

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

A heart/ lung biopsy is a standard test that can show whether your body is rejecting the new heart or lung. This test is often done 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 suggest 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 or lung problems.

Cardiac rehab includes counselling, 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

Your body will regard your new heart or lung as a foreign object. You’ll need medicine to prevent your immune system from attacking the heart.

You and the transplant team will work together to protect the new heart or lung. You’ll watch for signs and symptoms that your body is rejecting the organ. These signs and symptoms 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 sign)

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.

Your doctors may ask you 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 medicines are called immunosuppressants.

Immunosuppressants are 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 after having a heart/lung transplant. 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 a list of 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 include shortness of breath, cough, and a change in the colour of sputum (spit).

Watching closely for these signs is important because transplant medicines can sometimes mask them. Also, pay close attention to signs of infection at the site of your incision (cut). These signs can include redness, swelling, or drainage.

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


Pregnancy

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


Emotional Issues and Support

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

All of these feelings are normal for someone going through major heart/lung surgery. Talk about how you feel with your health care team. Talking to a professional counsellor also can help.

If you’re very worried, your doctor may recommend medicines or other treatments that can improve your quality of life.

Joining a patient support group may help you adjust to life after a heart/lung transplant. You can see how other people who have had the surgery have coped with it. Talk with your doctor about local support groups or check with an area medical centre.

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. This is available at St Vincent’s: check with the clinic and social worker.