Special Concerns Following Surgery

Infection

Every child undergoing surgery risks developing an infection.  The immunosuppressive medications your child will take to prevent rejection work by suppressing the immune system, the body’s natural defense against foreign substances.  Suppressing the immune system decreases the chances of the body’s rejecting the new heart or heart-lung.  But it also decreases the body’s ability to fight infection.

These steps will reduce the risk of infection while in the hospital:

• All family members and personnel will follow strict handwashing procedures.
• Visitors will be limited and screened.
• Your child may be asked to wear a mask when he’s well enough to leave his room.

Rejection

Rejection is the body’s reaction to the new organ and is a lifetime concern.  Nearly every transplant patient experiences episodes of rejection within the first three months, and we expect your child to experience this.  There may be few signs or symptoms of early rejection, so the best means of detection is by endomyocardial biopsy.

Approximately 10 to 14 days after surgery, we will do the first heart biopsy.  Your child will be medicated and taken to the cardiac catheterization lab.  As in previous procedures, doctors insert a catheter into the groin or neck vein and advance it into the heart.  Through the catheter they insert a special instrument, a bioptome, and remove (biopsy) a very tiny piece of heart tissue.  This sample is studied under a microscope to detect any evidence of rejection.

Depending upon the degree of rejection, we will adjust the antirejection medications.  This may require hospitalization.

Periodically, we will perform a biopsy to assess rejection.  Other studies, such as echocardiogram, electrocardiogram and blood-testing also may be necessary.

Accelerated coronary artery disease

This is another concern following a heart transplant.  It may result from low grade, chronic rejection.  To decrease this process, we recommend a heart-healthy diet and regular exercise.  

Once a year, we perform a surveillance cardia catheterization to image the coronary 
arteries to detect the onset of coronary artery disease.  Unfortunately, the only current treatment for this disease is retransplantation.