Recovery at the transplant centre

These are specialist hospital wards for patients that need constant monitoring. If you make good progress you will be moved from Critical Care to a post-operative ward after 2-3 days.

You will probably have a breathing tube down your throat, which may be uncomfortable. As soon as you are judged awake and alert enough to breathe on your own the breathing tube will be removed.

You will have several intravenous drips running into a vein (often in your neck). You are also likely to have monitoring equipment connected via a catheter in a large vein in your neck too. Almost all transplanted hearts are supported with intravenous medication immediately after surgery. This support is gradually decreased and discontinued over the first week.

Your urine output will be constantly monitored with a tube in your urinary bladder.

You will have 3-4 tubes coming out of your chest on both sides to drain any blood or fluid that accumulates at the site of surgery and to drain air if there is leak from the lungs into the chest cavity. These tubes will be removed in stages over the first 3-7 days depending on how much fluid comes out through them.

You will have wires attached to the heart and coming out of the chest connected to a pacemaker. In some people the heart rate may be slow for the first few days. The external (temporary) pacemaker is used to regulate the heart rate. In 96-97 in 100 patients, the wires attached to the heart can be removed after about two weeks. In 3 to 4 in 100 people the heart rate remains slow and a permanent pacemaker is implanted under local anaesthesia.

Around 15 and 20 of 100 patients will require mechanical circulatory support after a heart transplant lasting on average for 5 days. This is a machine that helps pump your blood for you.

You will have discomfort at the site of the wound in your chest particularly when you move, cough, or breathe deeply. The team looking after you will give you pain killers either intravenously or by mouth to control the discomfort. You may also need anti-sickness medication for the nausea you are likely to experience in the first few days.

Once you are well enough to move to a post-operative ward, you are likely to have no more than one drip in a vein. By this stage, you will usually be on painkillers by mouth.

Managing your pain

It is important that your pain is well controlled. There are specialist pain teams that can help, if needed.

Good pain control will help you get out of bed earlier, which works to reduce the risk of blood clots in the legs and lungs. However, painkillers have side effects, including sickness, itching, drowsiness, and constipation.

The nurses and doctors looking after you will keep a close eye on your pulse, blood pressure, temperature, weight and urine output. You will need regular blood tests, once daily or more in the intensive care unit and then about three times a week on the ward.

To start with you’ll need fluid to be given to you through a drip (intravenously), but you’ll be able to start drinking within a day or two of the surgery. The transplant team will see you at least once a day and advise you about this.

Within a day or two you will be helped to sit up in bed and encouraged to start walking. The nurses and physiotherapists will help you. It is very important to get out of bed as soon as possible after your operation to reduce the risk of blood clots in your legs and lungs and other problems after surgery.

You may feel quite bloated after your operation, as it is likely that your bowels will not be working properly for the first few days. Your transplant team will tell you when you can start eating and drinking again. You may need tablets (laxatives) to help you open your bowels. The sooner you get out of bed and start moving around, the sooner your bowels will start working.

If you are still constipated after having laxatives, you may need an enema (a medication given up your anus) to help you open your bowels.

You will only be discharged from hospital when:

• You are physically strong enough
• Your immunosuppressant medication levels are adequate
• You have learnt enough about your condition to look after yourself at home. This will include information about your medications, knowing how to look for symptoms of rejection or infection, and information about any lifestyle changes you need to make.

Many medicines might be prescribed after a heart transplant, for example to prevent rejection or infection, or to manage pain.

All patients that have a heart transplant will need immunosuppressants. These lower your immune system and reduce the chance of your body rejecting your new heart. 

Prior to discharge the nursing team will ensure that you and your support network are comfortable with your new medicines. You will be supervised for the first few weeks to make sure that you are able to take your medicines properly. 

Each transplant centre uses slightly different medication doses and types. Before you leave the transplant centre, you will be given detailed information about your medicines and how to take them. You’ll also be told what other medicines or food to avoid. 

It’s very important that you take all your new medicines as directed.

Learn more about transplant medicines

Please talk to your transplant team before you start taking any over-the-counter medicines or herbal medicines. This is because some non-prescription medicines and herbal medications can affect your immunosuppressant medications.

If you require extra support at home (for example, help with cooking, cleaning, mobility, wound care), this will be discussed with you before you leave hospital.

An appointment will be made for you in the heart transplant clinic and you’ll be told the date, time, and location of this visit. To start with, most patients will be seen within a week or two of discharge. Hospital transport can be arranged, if needed.

You will need to attend frequent clinic visits for the first year after a transplant. These will involve blood tests and heart biopsies. Your medication may be adjusted depending on the results of these tests.

After 12 months, your clinic visits are likely to go down to once every 3 months. After 2 years, you may only need to come to the clinic every 6 months for the rest of your life.