Children's Hospital Boston 300 Longwood Avenue
Boston, MA 02115
(617) 355-6000
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Clinical Services (Heart Transplant Program):
After Transplant
After surgery, how do you care for a heart transplant?
Sidney
Heart Transplant Patient, Sidney
After the surgery, your child will go to the cardiac intensive care unit (CICU) to be monitored closely. The length of time your child will spend in the cardiac intensive care unit will vary based on the specific, unique condition of your child after surgery. Once your child is stable, he or she will be sent to the special unit in the hospital that cares for heart transplant patients. Your child will continue to be monitored closely. You will be educated on all aspects of caring for your child during this recover period. This will include information about:
  • medications
  • activity
  • follow-up
  • diet and nutritional needs
  • any other specific instructions form your transplant team

What is the typical length of time that a child stays at the hospital after a heart transplant?
Anywhere from two to four weeks, but this can vary greatly depending on the child's condition prior to transplant.
What type of follow-up is needed after a heart transplant?
Children's Heart Transplant Patient, Shae
Children's Heart Transplant Patient, Shae
Your child will have very close follow-up with the transplant team after leaving the hospital. This will allow the transplanted heart to be closely monitored, as well as your child's health and well-being.

Follow-up visits in the clinic may include:

  • complete physical examination
  • blood work
  • echocardiogram
  • cardiac catheterization with biopsy
  • continued education for you and your Child
  • medication changes

Children who have received a heart transplant will need life-long follow-up with physicians who are specialized in transplant medicine. Keeping appointments with your child's transplant physician, as well as maintaining contact with the transplant team when symptoms of rejection occur, is vital. Parents and the heart transplant recipient, when old enough, are the first line of defense. They must understand, be aware of and recognize the symptoms of heart transplant rejection and report them as soon as possible to the transplant team.
What is the long-term outlook for a child after a heart transplant?
Mackenzie
Mackenzie, smiling at the Annual Heart Transplant Patient Picnic.
Living with a transplant is a life-long process. Medications must be given to the patient that have the ability to trick the patient's immune system into thinking that the heart belongs to that patient's body, so that the immune system will not attack the transplanted organ.

Other medications must be given to the patient in order to prevent side effects, such as high blood pressure, that can occur from taking the anti-rejection medications. It is essential that the patient frequently visits and contacts the transplant team. This is to ensure that a patient is watched and observed closely, on a daily basis, for any signs of transplant organ rejection, as this type of observation is critical for the long-term health of a transplant patient.

Eventually, when a child becomes old enough to independently care for himself or herself, he or she will need to learn about the proper usage of anti-rejection medications, what they do and how to continuously prevent and look for any signs of transplant organ rejection.

The length of time a child can live after a heart transplant is uncertain, as every child and every transplant is separate and different. As physicians and scientists continue to learn more about how the body deals with transplanted organs and search for ways to improve the success of transplantation, results will continue to improve.

What happens if the heart transplant doesn't work?
This is called rejection. Rejection is a normal reaction of the body to a foreign object. When a new heart is placed in your child's body, the body sees the transplanted organ as a threat and tries to attack it. The immune system makes antibodies to try to destroy the new organ, not realizing that the transplanted heart is beneficial. To allow the organ to successfully live in a new body, medications must be given to trick the immune system into accepting the transplant.
What are symptoms of rejection?
Each child can experience rejection symptoms differently. Many patients have rejection with no symptoms. In patients with symptoms, the following are the most common symptoms of rejection:
  • elevated heart rate
  • fast breathing rate
  • abdominal pain
  • vomiting
  • weight gain
  • irritability
  • poor appetite
  • decreased urine output or fewer diapers than usual
  • fever
If any of these symptoms occur, your transplant team will instruct you on who to contact immediately.
How can rejection be prevented?
Medications must be given for the rest of the child's life to fight rejection. Each child is unique, and each transplant team has preferences for different medications. Some of the anti-rejection medications most commonly used are:
  • cyclosporine
  • tacrolimus
  • mycophenolate mofetil
  • steroids (prednisone or methylprednisilone)
  • azathioprine
  • thymoglobulin

Because anti-rejection medications affect the immune system, children who receive a transplant will be at higher risk for infections. A balance must be maintained between preventing rejection and making your child very susceptible to infection. Blood tests are performed periodically to measure the amount of medication in the body, to ensure your child does not get too much or too little of the medication.
What about infection?
The risk of infection is especially great in the first few months, because higher doses of anti-rejection medicines are given during this time. Your child will most likely need to take medications to prevent other infections from occurring. Some of the infections your child will be especially susceptible to include:
  • oral yeast infections (thrush)
  • viruses (herpes, EBV)
  • respiratory illnesses
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