Heart transplant: What happens after surgery?

After a transplant, your body's immune system (responsible for fighting off infection and disease) will recognize that your new heart is not a natural part of your body and begin to attack it. You will need to begin a regimen of immunosuppressive drugs immediately after surgery to prevent your body from rejecting your new heart. Examples of such drugs are cyclosporine, azathioprine, and corticosteroids. Because your body will always try to attack your new heart, you must take these immunosuppressive drugs for the rest of your life. Unfortunately, these drugs will also weaken your body's ability to fight common infections.

What can I expect during recovery? You will spend about 1 to 2 weeks in the hospital after surgery. You may have to stay longer depending on your health and if you have complications from surgery. While in the hospital, you will start rehabilitation. And your doctors will check on your heart to make sure your body is not rejecting it.

The first year after a transplant. The first year after a heart transplant is considered a critical time. The 1-year survival rate for transplant recipients during this period is 79%. This is a very high rate considering the complexity of the surgery and the risk of complications.¹

To have the best chance of surviving the first year after your transplant, make sure that you take your immunosuppressive drugs correctly and visit your doctor consistently. You will need to have frequent heart tests (endomyocardial biopsies) performed to watch for early signs of organ rejection. During an endomyocardial biopsy, a sample of your heart tissue is removed using a catheter placed inside your heart. The tissue is then viewed under a microscope. Doctors often can spot early signs of organ rejection from these samples. Your doctor may want to do other tests that monitor your immune system, electrocardiograms, or echocardiograms to test for additional signs of organ rejection.

The long-term picture. Of people who survive their first year after a heart transplant, the average life expectancy is 11.5 years. Over 90% of people who survive for 4 years after a heart transplant have no limitations on their activity, and 40% return to work. These statistics show a dramatic improvement over the high death rate common among people with class IV heart failure. These statistics also are the reason why heart transplants have grown in popularity as a treatment option for severe end-stage heart failure.²

Citations

1. Hunt SA, et al. (2001). Cardiac transplantation, mechanical ventricular support, and endomyocardial biopsy. In V Fuster et al., eds., Hurst's The Heart, 10th ed., vol. 1, pp. 725–747. New York: McGraw-Hill.

2. Miniati DN, et al. (2001). Heart and heart-lung transplantation. In E Braunwald et al., eds., Heart Disease: A Textbook of Cardiovascular Medicine, 6th ed., vol. 1, pp. 615–634. Philadelphia: W.B. Saunders.