What medications will my patient receive after treatment?
- Patients are started on lifetime immunosuppression, Tacrolimus (Prograf, FK506) and Mycophenolate motefil (Cell Cept) within days of the transplant and undergo induction therapy with high dose steroids and thymoglobulin for the first five days.
- Some patients are kept on a maintenance dose of oral steroids (prednisone). Several medications are used to prevent infection: Bactrim or Atovaquone (PCP prophylaxis), Nystatin or Mycelex (thrush prevention) and Valcyte (prevention of viral transmission).
- Other medications include ace inhibitors (Captopril, Enalapril), diurectics (Furosemide), acid blocker (Ranitidine, Omeprazole), cholesterol lowering agent (provachol), blood thinners (aspirin) and electrolyte supplements (magnesium, potassium).
- Medication list is weaned down dramatically over the first year. The patient is typically on three to five medications a year post transplant.
Are there any nutritional restrictions?
Heart transplant recipients are instructed to maintain a "heart healthy" diet for the rest of their life. This diet is low in saturated fats, cholesterol, salt and concentrated sweets. The family is educated on this diet over the first several months post-transplant.
What should I know about medication interaction for heart transplant recipients?
There are many drug-drug interactions with the immunosuppression regimen, so caution should be used when giving any new medication. Particularly, drugs metabolized via cytochrome p450 metabolism pathway must be used with caution. Tacrolimus (Prograf, FK506) is metabolized via this pathway and the levels can be dramatically altered.
Examples of medications that can alter the levels include: erythromycin, dilantin and other anti-seizure medications, antifungal agents such as ketoconazole, fluconazole, and itraconazole, as well as calcium channel blockers.
If you must prescribe any of the medications, please contact our office at 617-355-6329 in order to ensure close monitoring of drug levels.
Because of the long-term nephrotoxic effects of tacrolimus, medications that are renally metabolized are used with caution. We advise against the use of all nonsteroidals.
Standard cold preparations that have phenylephrine or pseudophedrine are also avoided.
What types of immunizations should be administered?
Because heart transplant patients are immunocomprimised, they should not receive any live vaccines. Immunizations should not be given within three months of transplant or in the midst of a rejection episode.
Immunizations heart transplant recipients should receive:
- Full vaccination series for Hepatitis B, DTAp, HIB, IPV, pneumococcal, meningococcal and yearly flu vaccines
- Synagis in special circumstances
Are there any physical restrictions for a child after heart transplantation?
Most competitive physical activity is allowed six to eight weeks post heart transplant. Once the patient completes a rehabilitation program they are allowed to participate in age-appropriate activities. We generally advise against varsity-level contact sports (e.g. hockey, football).
Should I look for anything in particular when examining a heart transplant patient?
Screening is extremely important for our heart transplant patients. Being proactive in the search for potential issues is the key. Any sign of heart failure can be a sign of rejection and must be responded to quickly. Please report any suspicious symptoms.
Rare infections (CMV, EBV) can present themselves in the immunosuppresed patient and must be responded to quickly. Because of the risk of post-transplant lymphoproliferative disease (PLTD), careful examination of lymph nodes at each visit is important.
When should I contact the heart transplant program at Boston Children’s?
For patients waiting for a heart transplant:
We ask you to keep us informed of any changes in medical condition, any admissions to the hospital, any serious infections and any psychosocial concerns. These may affect the patient's listing and will help us provide the opportunity for successful transplantation.
For heart transplant recipients:
We would like to be notified of any significant illness, fever (>100.5 degrees), fatigue, chest pain, heart rhythm abnormalities, swelling, abdominal pain, lymphadodenopathy, and excessive diarrhea/vomiting or compliance issues, hospitalizations or recurrent problems.
- Hours: Monday - Friday, 8:30 a.m. to 5 p.m.
- Direct Line: 617-355-6329
- Direct Fax: 617-734-9930
For urgent matters during off-hours or weekends, please page the Heart Transplant Cardiologist on-call via the page operator at 617-355-6363.