University of Virginia Health System

Heart Transplantation

After the Transplant

Returns to Clinic

After the transplant, patients enter into a new phase of care that lasts indefinitely. Here is the schedule for post-transplant visits to the tranplant clinic:

• Regular monthly visits to the heart transplant clinic are an important means of checking on progress and catching any signs of organ rejection at the earliest point. A biopsy of the heart is conducted with each visit.
• After the first year, visits to the clinic are reduced to every three months (and biopsies are performed twice yearly).
• During the third year after transplant, an annual visit is required, and a biopsy will be performed at the visit.

Monitoring Cardiac Health: Lab Tests and Their Results

Regular monitoring of patient and organ health requires regular testing by a lab, and reporting of the results to the transplant team. Here is the schedule:

• Every Monday for the first three months after transplant, then
• Twice monthly (2nd & 4th Monday) until the end of the first year, then
• Monthly (on the first Monday of the month) during the 2nd year after transplant, then
• Every three months thereafter.

Results are sent (usually, from the lab directly) to the transplant office and become an important record through which the transplant team can monitor the recipient's cardiac health and alter the program of care to meet the patient's needs. Faithful completion of the lab regimen is critical for ongoing good health.

Heart Transplant Rejection and Infection

A transplanted heart is considered foreign by the body's immune system. Despite the regular use of anti-rejection medications, patients may undergo several episodes of rejection (usually within the first three months of receiving the transplant). The likelihood of rejection declines after the first year. We anticipate that rejection will occur and it is not a complication related to surgery.

Anti-rejection (that is, immunosuppressive) medications suppress the body’s immune (defense) system, thus preventing the body from recognizing the transplanted heart as “foreign.” These medications, are extremely important in prolonging the life of the transplanted organ and thus the transplant recipient. Tacrolimus (Prograf), azathioprine (Imuran), mycophenolate mofetil (Cellcept), sirolimus (Rapamune) and prednisone are anti-rejection medications that may be used in combination to manage rejection of the new heart. Over time the list of medications and their dosage may change according to the patient's needs, but anti-rejection medications will be required for life. Unfortunately, they also have some risk of undesirable side effects, such as kidney dysfunction, increased risk of infections and cancers. Transplant recipients who stop taking their medications generally die in one to four weeks.

Other medications taken by transplant recipients also play an important role in maintaining the health of the transplanted heart. Symptoms of rejection are similar to heart failure symptoms and may include new onset shortness of breath, a decrease in exercise capacity, swelling and irregular heart rhythm. When these symptoms appear, testing is done to confirm instances of rejection or infection; this may occasionally require inpatient treatment.

We understand that rejection episodes can be difficult, even frightening times, for patients and their families. Patients should realize that acute rejection is a very treatable side effect of transplant.