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Living with a Heart Transplant
Patients routinely stay in the surgical cardiac intensive care unit (CICU) for five to seven days after surgery. Then they are transferred to another floor within the hospital for 10 to 14 days until discharge.
Patients are usually discharged home four weeks after the heart transplant. Patients who live more than one hour's travel time from UF Health Shands Hospital may stay locally in transplant housing.
Biopsies are done according to schedule:
- Weekly for the first four weeks
- Biweekly for the next four weeks
- Monthly for the next two months
- Every two to four months thereafter to complete the first year
Six months after the transplant, cardiologists perform a left heart catheterization with selective coronary angiography and a right heart catheterization for an endomyocardial biopsy. These catherizations are repeated annually until the patient is five years post-transplant. All annual studies include laboratory work, chest X-ray and an EKG.
Biopsy results, physical exam findings, vital signs, laboratory studies and medications are communicated to the primary care physician by the medical director using a database-driven summary employed by the coordinators. The clinic visit and laboratory schedules outlined above are minimum and may vary. All follow-up care, including clinic visits and laboratory tests, may vary.
Long Term Care
Heart transplant recipients are followed throughout their lives by a team of health care providers. Patients are followed more intensely during the first six post-transplant months because most serious complications occur during this period. In time the frequency of laboratory tests and doses of immunosuppressive agents are tapered. Some complications that more commonly present later.
Patients vary in need for after care and in the side effects they experience from the immunosuppressive agents (cyclosporine, prednisone and azathioprine.) An attempt is made to reduce or discontinue steroids by six months following transplant while maintain adequate cyclosporine or prograf levels. Clinical complications such as frequent rejection episodes, bone disease, severe cushingoid features or infections may lead to a delay or a more rapid tapering of the steroid dose as dictated by the particular complication.
Rejection is diagnosed by an endomyocardial biopsy procedure in the cath lab. Treatment usually involves a short-term course of high dose steroids.
Lymphoproliferative disease can sometimes be associated with the donor/recipient Epstein Barr virus status and the amount of immunosuppression used. Polyclonal expansions of lymphocytes, diagnosed histologically, by flow cytometry and by cell typing, usually respond to reductions in immunosuppression.
True monoclonal lymphomas are treated by drastic reductions in immunosuppression (for example stopping cyclosporine, decreasing azathioprine and steroids) and the addition of antiviral agents such as intravenous acyclovir. There is little evidence for the use of interferon or standard lymphoma chemotherapeutic regimens to treat post-transplant lymphomas.
Malignancies are another danger for heart transplant patients. They are at an increased risk for skin and cervical cancers. Female patients are advised to have annual Pap smears to screen for cervical cancer. A careful skin exam is performed during clinic visits. Patients are referred to dermatologists for any suspicious lesions. Patients are also advised to minimize their exposure to the sun by wearing sunscreen.