Follow-up Medical care after Heart Transplant

August 22 10:22 2022 by admin Print This Article

Kauvery’s Heart Transplant Team

Heart Failure is one of the serious conditions that affect the heart. It can be caused by a wide range of heart conditions such as cardiomyopathy, which is a weakening of the heart muscle, ventricular arrhythmias (which is a type of abnormal heart-rhythm) that is recurring, diseases of the heart valves, congenital heart defects which are heart problems one is born with, and coronary artery disease (CAD).

When none of the treatments for the above conditions are working out, there is a high risk of heart failure. And when that happens, a heart transplant is the only viable option. A transplant may also be performed when a previous heart transplant has failed.

Patients who need a heart transplant are put on a national transplant list by doctors when heart failure appears inevitable. Cadaver donors (hearts taken from a person who has expired recently) from near-by cities/locations are preferred as the heart can be kept in good condition for 4-6 hours maximum, after removal from the donor’s body. The recipient is prepared for the surgery with suitable care and the transplant is done.

Immediately after the Surgery

The patient will be moved to an ICU immediately after the surgery and would wake up there. Machines at the ICU shall monitor all the vitals. An endotracheal tube connected to a respirator shall help the person breathe. Drainage tubes connected to the chest help drain out fluids that accumulate around the heart and lungs. An IV line through the neck would be used to administer vital medications.

There may be pain. The new heart would be breathing faster than normal, initially. The medical and nursing staff would be monitoring the same. They would also teach the patient deep-breathing and coughing exercises that help cough out any secretions from the lungs. The patient would be helped to shift position from time to time.

Medication

There are a wide range of medicines to be taken following a heart transplant.

• Immunosuppressant drugs: As the name implies, these suppress the immune system and prevent it from attacking the new heart which it may identify as a foreign body or pathogen. These medicines must be taken for the rest of the life and may include: Cyclosporine, Tacrolimus, Azathioprine, Prednisone and Mycophenolate Mofetil.
• Anti-Hypertensives: One of the side-effects of the above Immunosuppressant drugs is high BP or hypertension. To counter that, drugs such as Calcium Channel Blockers, Diuretics, ACE Inhibitors, Minoxidil and Clonidine are given.
• Lipid-lowering medication: Another side-effect of immunosuppressant drugs is that they can raise the cholesterol levels in the body. So, drugs are given to prevent that and reduce the risk of Coronary Artery Disease (CAD).
• Anti-Infective Agents: these help prevent bacterial, viral and fungal infections that are possible after a transplant. These drugs include Clotrimazole, Co-trimoxazole, Nystatin, Acyclovir and Ganciclovir.
• Anti-Ulcer Medications such as Omeprazole, Famotidine and Ranitidine.

Caring for the Incision

The incision in the chest area must be kept clean and dry at all times. After a few days of discharge, if the incision appears to be healing, the person can take a quick shower. The incision can be gently sprayed with soap water. However, the incision or the scabs must not be rubbed or, no dressings, lotions and ointments should be applied there. There will also be restriction on vehicle driving for 6-8 weeks after surgery. The person should not lift weights over 10-20 pounds for nearly 6 weeks after transplant surgery.

Monitoring for Infection

Because the person is taking immunosuppressant drugs now, he/she is vulnerable to a range of infections (called opportunistic infections).

• Bacterial infections that include pseudomonas, staph and strep among others
• Viral infections such as CMV or Ganciclovir, Hepatitis, HIV, Herpes simplex and Herpes zoster
• Fungal infections such as Histoplasmosis, candida and aspergillosis
• Other infections such as Pneumocystis and Tuberculosis

The doctors will educate the patient about symptoms of these infections, so that in case they show up, the patient can seek urgent medical help.

Monitoring for Complications

In addition to Infections mentioned above, there are a whole lot of other complications. This includes first and foremost – rejection of the new heart by the body. Other complications are hypertension, kidney dysfunction, liver dysfunction, bone-marrow suppression, increased risk of cancers such as skin and lip, bone-loss and weakness, impotence, high potassium levels in the body, coronary artery disease and biopsy complications (due to repeated biopsy that check for rejection risk). All the follow-up medical care will look for signs and symptoms for any of these complications.

Diet and Nutrition

It is very important to eat a heart-healthy diet following transplant. This will require:

• Eating a diet low in salt, sugar and fat
• Proteins must come from lean meats such as fish and poultry, beans and lentils, and nuts.
• Carbohydrates must be of the complex variety that come from whole grains.
• Vitamins and minerals that come from fresh fruits, vegetables and low-fat diary

Some of the medication taken can affect the magnesium, potassium and phosphorus levels in the body. So, a qualified dietician or nutritionist shall advise the patient on potion size of each nutrient, what to eat, what to avoid etc.

Exercise

The new heart must not be strained too much, but must also be gently exercised so that it begins to adjust to functioning under load. Further, the new heart is only 70 percent as efficient as a normal heart (healthy heart before transplant), so regular exercise is important to ensure the heart is working normally, for the rest of the life. So, a physiotherapist would advise the patient on dos and don’ts.

• The person should do light activities like eating, shaving, bathing, dressing and using the bathroom, on his/her own.
• Lifting children, pets, shopping bags and suitcases are to be avoided.
• Driving is not recommended while biking, trekking, swimming or cycling must be done in moderation. Exercises in the gym must be restricted to light cardio and light weights.
• The person must pace himself/herself all through the day so that nothing is rushed and there is no stress for any reason as this can trigger hypertension.
• A good night’s sleep is absolutely vital and the person can also take naps once or twice a day.

Follow-up Medical checks

The patient will have regular follow-up visits to the doctor as per a given schedule:

• Up to 2 months after transplant — visit once in 2 weeks
• Between 3 to 6 months after transplant – visit once a month
• Between 7 to 12 months after transplant – visit once in 2 months
• Every visit will involve checking vitals like heart rate, blood pressure, pulse, temperature and blood sugar.
• Any signs and symptoms for above mentioned complications and infections will be observed.
• Blood tests, ECG or EKG, chest X-ray and heart biopsy will be done periodically to look for signs of heart rejection if any. The frequency will reduce with time.

Adjusting to the new life

A heart transplant can affect several aspects of one’s life including work, hobbies, sports, sexlife, social life, the finances, new schedules and restrictions that would require adjusting by family members, and dealing with emotions involved. A reputed hospital will offer counselling services that would make this transition and adjusting to the new life easy. The hospital may also connect the patient with other transplant patients or support groups where a lot of information, tips, tricks and hacks would be shared on a daily basis. Further, cardiac care is a highly sophisticated specialty today. Doctors are aware of all the challenges that transplant patients go through and would provide leads or inputs on how to make the journey easy.

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Frequently Asked Questions

1. What medications are typically prescribed after a heart transplant?

Following a heart transplant, patients take immunosuppressant medications to prevent rejection, anti-hypertensive to manage blood pressure, cholesterol-lowering medications, anti-infective agents to fight infections, and medications to prevent ulcers.

2. How often are follow-up appointments needed after a heart transplant?

Follow-up appointments are frequent in the beginning, with visits every 2 weeks for the first 2 months. Gradually, these become less frequent, happening monthly between 3-6 months, and every 2 months between 7-12 months.

3. What are the signs and symptoms of infection after a heart transplant?

Due to suppressed immunity, transplant patients are more susceptible to infections. Be aware of fever, chills, fatigue, pain, cough, shortness of breath, urinary issues, or unusual vaginal discharge.

4. What dietary recommendations are followed after a heart transplant?

A heart-healthy diet is crucial post-transplant. This means limiting salt, sugar, and fat while consuming lean proteins, complex carbohydrates from whole grains, and plenty of fruits and vegetables.

5. What types of exercise are recommended after a heart transplant?

Gentle exercise is encouraged to help the new heart adjust. Light activities like walking, swimming, or light gym workouts are suitable. A physiotherapist can guide you on a safe exercise plan.

6. How can I emotionally adjust to life after a heart transplant?

 A heart transplant can be emotionally challenging. Reputable hospitals offer counselling services to help patients navigate this transition and connect with support groups for shared experiences and emotional well-being.

Reviewed by Dr Suresh S Venkita, Group Medical Director, Kauvery Hospitals

NOTE: Take medications only when prescribed by your doctors, self-medication must be avoided under any circumstances.

Kauvery Hospital is globally known for its multidisciplinary services at all its Centers of Excellence, and for its comprehensive, Avant-Grade technology, especially in diagnostics and remedial care in heart diseases, transplantation, vascular and neurosciences medicine. Located in the heart of Trichy (Tennur, Royal Road and Alexandria Road (Cantonment), Chennai, Hosur, Salem, Tirunelveli and Bengaluru, the hospital also renders adult and pediatric trauma care.

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