Heart Transplant

About

Transplant preparation

A transplant cardiologist and surgeon and, in some cases, doctors trained in pulmonary medicine and nephrology evaluate you. You may also meet with doctors trained in endocrinology, psychology and infectious diseases. Certified transplant coordinators and licensed social workers assist you and your family during and after the evaluation.

The evaluation toward heart transplantation at Mayo Clinic consists of two phases.

• Phase 1. Your initial appointment involves a visit with a nurse practitioner and with a cardiologist (heart specialist), lab tests, an echocardiogram, chest X-rays, a treadmill exercise test and a visit with a social worker. After you complete Phase 1, your doctor will determine whether you require further evaluation. If so, your doctor will determine when you should return for Phase 2 of the evaluation.
• Phase 2. During Phase 2, you'll complete five to seven days of more invasive testing, including a visit with a transplant surgeon and a cardiologist (heart specialist), blood and tissue typing, antibody analysis, evaluation of your immune status, right-heart catheterization, renal (kidney) function tests and possibly other tests. Your doctor also will determine how quickly you must complete the evaluation to be placed on the transplant waiting list. If possible, someone should accompany you to Mayo Clinic.

If your doctor determines that transplantation isn't the most appropriate option, the transplant cardiologist can refer you to another specialty area at Mayo Clinic.

Approved for transplant

If you're approved for transplantation, your doctor will place you on the United Network for Organ Sharing (UNOS) waiting list. While you're on the list, you'll see your primary care and transplant doctors at regular intervals. There's no way to predict how long you'll remain on the wait list.

If you become medically unstable while awaiting transplantation, your doctors may order intravenous drugs or mechanical support. Low doses of a heart stimulant drug often are effective in restoring acceptable heart function while you await a donor heart.

If necessary, Mayo Clinic surgeons may implant mechanical univentricular or biventricular assist devices to aid circulation for weeks or months. Such devices allow you to be ambulatory and active, and your doctor may dismiss you from the hospital with a ventricular assist device in place.

Mayo Clinic can help coordinate air transportation to ensure rapid travel to Mayo Clinic when a donor organ becomes available. You might travel to any of the three locations for your transplant, based on organ availability and referral. As the time for transplant approaches, you may consider relocating to be near the center where you'll receive your transplant.

Receiving an organ

Mayo Clinic is a member of UNOS and is in constant contact with professionals from national and regional organ-procurement agencies in the upper Midwest, northeast Florida and Arizona. Your name will be entered into national and regional data banks to help minimize the waiting time for matched donor organs.

When you receive notice that a compatible donor heart is available, you must return to Mayo Clinic immediately. Your transplant cardiologist will perform an examination to ensure that you're able to undergo the transplant. Before making the final decision to proceed with the transplant, the transplant surgeon retrieving the heart will assess the organ.

After transplantation

Adult heart transplant recipients usually remain in the hospital for seven to 14 days after surgery. Your education and physical rehabilitation begin soon after surgery and continue after discharge.

In the early post-hospital phase, Mayo Clinic's transplant team will see you several times per week. Eventually, these visits will decrease to one per month. Your doctors likely will ask you to remain in the area for monitoring for three months after transplantation.

After transplant, you'll need daily, lifelong immunosuppressive medication to prevent rejection of your newly grafted heart. Your doctor may recommend other immunosuppression treatments including radiation or plasmapheresis.

Because rejection is often subtle until severe, Mayo Clinic doctors perform routine surveillance right ventricular endomyocardial biopsies on adults to monitor for rejection. They do these biopsies with local anesthetic on an outpatient basis. Doctors perform biopsies weekly for a few weeks, then gradually decrease the frequency.

Follow-up care at home

After returning home, you should see your primary doctor regularly and undergo quarterly right ventricular endomyocardial biopsies. If your doctor wishes to assume some or most of your continuing care, this can be arranged. If your doctor performs the biopsies, Mayo Clinic cardiac pathologists can interpret the biopsy. In all cases, you'll be asked to return to Mayo Clinic annually for coronary angiography and general evaluation.

After heart transplantation, you may develop high blood pressure or poor kidney function (renal insufficiency) as a result of the immunosuppressive drugs. Your doctors also will watch for tumors and coronary artery disease.