Support Person
Keeping track of daily meds and vital signs plus attending cardiac rehabilitation, coming to appointments, eating healthy, and getting enough rest is a FULL TIME JOB for the patient during the first few months. The help and support of a dedicated support person is critical during this time. The support person will be taught the same things that the patient is and will be expected to assist them with medications, monitoring vital signs, and recognizing symptoms to call the nurse coordinator for. In addition, they may need to cook for the patient, help them with daily activities, and provide transportation because the patient is not allowed to drive for a minimum of 6 weeks after surgery. Sometimes several people share the support person role if it is too intense for any one family member or friend.

Clinic Visits
Clinic visits after transplant will include blood tests, echocardiograms, and visits with the transplant cardiologist and nurse coordinator. Transplant education will continue in the clinic as needed.

Biopsies
Biopsies of the new heart are done every week for the first 6-8 weeks and then less frequently to check for rejection. During a biopsy a thin catheter is threaded through a vein in the patients' neck or groin and into the right ventricle of the heart. Several tiny pieces of the heart tissue are removed through the catheter. The doctor looks at these pieces under a microscope to tell if rejection is occurring.

Rejection
Rejection happens when the patient's immune system recognizes that the transplanted heart is "foreign" tissue and tries to attack it. It can range from mild to life threatening. The job of rejection medicines (immunosuppression) is to "trick" the immune system into not seeing the heart as foreign tissue. Right after a transplant patients are on high doses of rejection medicines (Cyclosporine or Tacrolimus, Mycophenolate or Azathioprine, and Prednisone). Over the first few months these medicines are weaned down gradually because it is important that patients take only as much rejection medicine as they need and not more. This is because rejection medicines have lots of side effects and put patients at higher risk of getting infections. The only way to know for sure how much rejection medicine an individual patient needs is to biopsy the heart and check for rejection because often rejection does not have any symptoms. Rejection does NOT mean the heart is irreversibly damaged and usually does not require that the patient be readmitted to the hospital for treatment.

Infection
Infections are not uncommon in transplant patients because of the immunosuppression required. Symptoms of infection, especially in the early post-transplant period, might require re-hospitalization. It is important to identify the germ causing the infection if possible so it can be treated correctly. Infections can be caused by bacteria, viruses, fungus or other germs. Often a doctor that specializes in care of patients with infections will help the transplant cardiologist manage these patients. Treatment of infections might involve lowering the immunosuppression. This, in turn, can increase the risk of rejection. It is very important that patients notify their transplant nurse coordinator of any signs of infection and that the transplant center is involved in diagnosis and treatment of infections after a transplant.

Post Transplant Coronary Artery Disease
Periodic angiograms or stress echocardiograms will be needed to see if the transplanted heart has developed any coronary artery vasculopathy. This can develop after transplant and is a type of chronic rejection that affects the coronary artery walls instead of the muscle itself. The artery walls become thickened and this can impair blood flow through the arteries. This process can start soon or many years after transplant. Sometimes it progresses rapidly and sometimes it starts and then stabilizes without progressing further. If the process is bad enough it can clog the arteries enough that another transplant may be needed.

Cancer
Cancer screening is important because people who are immunosuppressed are at more than the usual risk for developing certain kinds of cancer (malignancy). Examples are skin cancer and lymphoma, a type of blood cancer.

Right Heart Catheterization or Hemodynamic Assessment
A special catheter is used to measure the pressure in the right sided chambers of the heart (right atrium and right ventricle) and in the blood vessels that go from the heart to the lungs (pulmonary artery). A catheter is placed into a large vein in the neck. It then passes down into the right sided chambers of the heart. If the pressures are normal the catheter will be taken out. If the pressures are elevated the catheter may be left in and the patient would remain in the hospital while medications are adjusted.

Cardiopulmonary Exercise Test
This test is physically very demanding. It assesses how well the heart, lungs, blood vessels and muscles work together to burn oxygen as fuel during exercise. Pulmonary function tests are done prior to starting the test. During the test, the heart rate, blood pressure and breathing is monitored while the patient rides on an exercise bike or walks on a treadmill. Arterial blood samples will also be taken.