Patient discharge and recovery

You can call (352) 265-0751 to make a referral to the heart transplant program at the Shands Transplant Center at the University of Florida.

Patients routinely stay in the surgical cardiac intensive care unit (SICU) 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 from Gainesville at four weeks after the heart transplant. Patients who live more than one hour's travel time from Shands at the University of Florida 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 and endomyocardial biopsy. These catherizations then 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.

Long term care
Lung transplant recipients are followed throughout their lives by a team of healthcare 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.

Patients vary in need for aftercare and in the side effects they experience from the immunosuppressive agents. Follow-up may vary. The clinic visit and laboratory schedules outlined are minimum and may vary. In general, patients are chronically immunosuppressed with cyclosporine, prednisone and azathioprine.

An attempt is made to reduce steroid doses (to about 10 mg per day at six months post-transplant) while maintaining adequate cyclosporine levels. Clinical complications such as frequent rejection episodes, bone disease, severe cushingoid feature or infections may lead to a delay or a more rapid tapering of the steroid dose as dictated by the particular complication.

The first six months represent the greatest risk for most recipients of lung transplants. There are some complications that more commonly present later.

Chronic rejection can usually be differentiated from recurrent or persistent acute rejection by transbronchial biopsy and clinical response to augmented immunosuppression. Most cases of chronic rejection are diagnosed by clinical criteria. These criteria include a relentless decline in FEV1, unresponsive to augmentation of the immunosuppression regimen and the absence of infection. Patients with advanced chronic rejection are considered for retransplantation.

Lymphoproliferative disease (LPD) can sometimes be associated with the donor/recipient Epstein Barr virus (EBV) status and the amount of immunosuppression used. Polyclonal expansions (mononucleosis-like) 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 lung 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 carcinomas. A careful skin exam is performed during clinic visits. Patients are referred to dermatologists for any suspicious lesions. They are also advised to minimize their exposure to the sun by wearing sunscreen.

Statistics
Success rate and various other statistics regarding the Shands Transplant Center at UF are available from the Scientific Registry of Transplant Recipients at ustransplant.org.

Related Links
CHF Patients

Transplant Navigation

Heart and Lung Transplant

Heart Transplant Navigation

Pediatric heart transplant

Process

Programs

Recovery

Make an Appointment

To make an appointment or find out more information about transplant services offered at Shands at the University of Florida, please call 352.265.8000 or toll-free 1.800.749.7424

You may also email our Consultation Center (consult@shands.ufl.edu) or use our secure online form.