Life After Transplant

Once you are discharged from the hospital you will be seen in the out-patient clinic twice a week for about two weeks, on Mondays and Thursdays, Then once per week on Monday or Thursday, then once every 2 weeks for about 3 weeks, then once a month until you are out six months, then once every two months until you are year out from transplant.

A clinic day usually involves an echocardiogram(30-45min), a blood draw (20min), a clinic visit which will include a visit with the Nurse Coordinator, a visit with either the Nurse practitioner or Transplant cardiologist fellow, a visit with the Attending Transplant Cardiologist, and possibly a visit with the dietitian, social worker and pharmacist.(20-45 min), a chest x-ray (20 min), and a biopsy (30-45 min). The wait time in the cath lab is variable and inconsistent due to the cath labs operating schedule (emergencies go first etc.). On these days you can expect the better part of your day to be in and around the medical center.

Also on clinic days you need to find time to eat and rest, and many patients find the first days as an out-patient tiring and one can certainly enlist the aid of a wheelchair to get around, it can be a long day.

The cath lab experience

One way to adequately determine whether or not you are experiencing rejection is to complete a heart biopsy. Your biopsy will be performed at the Stanford Catherization Lab or cath lab. Most patients at the cath lab are in the process of being evaluated and diagnosed with serious cardiac ailments. The waiting room can be tense as families and loved one process the information doctors are trying to explain. A few patients are taken directly from the lab to surgery. You, as a post-transplant patient, are considered an elective or non-urgent procedure, and therefore there are times when the urgent cases get pushed ahead of the biopsies. Be on time, but consider your appointment time as a best effort. Relax; take advantage of the wait, if there is one, to catch up on your reading. Get something light to eat. The cath lab makes every effort in keeping you informed of their schedule and where you stand.

The annual exam

An annual exam is the once a year evaluation that includes all of the routine clinic appointment needs (MD visit, echocardiogram, labs, chest X-ray) but also an ECG, a coronary arteriogram or angiogram, early patients (year 1-5) usually get a intravascular ultrasound (IVUS) as well. The (IVUS) is done in the same way as the angiogram, and a biopsy is done depending on your rejection history or years out from transplant. This “ annual” takes up two days, and does not include an overnight stay. Day 1 includes all the studies except the angiogram/IVUS and biopsy , and Day 2 is the angiogram and biopsy. After the angiogram one must stay flat on your back for 4-6 hours so that the groin entry site heals. Therefore the entire procedure and recovery phase takes about 8 hours. Please make sure you have someone drive you home after this procedure. 

Human sexuality and fertility in the transplant recipient

Many patients have concerns about sexual activity after transplant. After heart transplantation, which occurs through a sternal or chest incision, it is advised to maintain sternal healing precautions. Sternal precautions are to prevent uneven stress on the incision by not exerting unequal strain on one side or the other, such as lifting heavy objects, lifting  or straining one side of the body over the other. These precautions are advised for 8-12 weeks after surgery. After 12 weeks sexual activity can resume as one feels up to the activity and without fear of injury.

Fertility (the ability to produce eggs in the female and produce sperm in the male) is not stopped or perhaps not even interrupted by surgery, the transplant, or the immunosuppressants and other medications.  Therefore for women of childbearing potential and men who are sexually active who do not wish to become pregnant or father children, birth control needs to practiced. 

Women of childbearing potential should see their Obstetrician and gynecologist doctor (OB-GYN) soon (within 3-6 months) after transplant to discuss birth control options. Every individual will have different needs based on age, prior gynecologic history, and medical status, such as presence of high blood pressure, diabetes, years post-transplant.

Women who are transplant recipients and are considering having children should have a thorough discussion with their physicians regarding risk on their health. Transplant poses special considerations that must be addressed. Some patient may want to discuss questions with a genetic councilor. A genetic counselor is available at Stanford.

Genetic Counselor: Colleen Caleshu, MS, CGC
Stanford Center for Inherited Cardiovascular Disease
Phone: 650-725-6273
Fax: 650-498-7452

Sexual dysfunction

Safe sexual activity may be resumed without concern after incisional healing, usually within six to eight weeks following surgery. If sexual dysfunction occurs, feel free to discuss it with your physician.

Sexual concerns after heart transplantation are commonly experienced yet seldom voiced. The sensitivity of the topic may prevent open discussion with your health care providers and can delay referrals, changes in medications and treatment. The best advice is to inform your provider so that appropriate evaluation and suggestions can be considered.

Erectile dysfunction (ED) is prevalent in male patients who have cardiovascular disease and in patients who are on high blood pressure medication. ED should be reported to your primary care doctor and/or your transplant cardiologist  as soon as possible so that referrals or treatment can be done as soon as possible.

Lifestyle changes

• Dishes do not need to be sterilized.
  
• Bed linen may be laundered routinely and does not need to be changed on a daily basis.
  
• Pets offer no threat of disease with the exception of toxoplasmosis, which is found specifically in cat feces. Do not change kitty litter boxes.
• Indoor or outdoor activities are limited only by the threat of potential injury or the limits of physical stamina. Use common sense in all activities. Restrictions apply only when there are extremes in pressure changes such as flying in unpressurized cabins, gliding, hang gliding, and scuba diving.
  • The physiologic response of the denervated heart is different from normal, and the lack of normal reflexes may be hazardous in these activities.
• Swimming in clean pools and the ocean is an excellent form of exercise, and relaxing in a clean hot tub is acceptable after full recovery. There is no need to restrict exposure to the general public. You may attend movies, sports events, parties, etc.