Patient's Guide to Heart Transplant Surgery
It is important that you realize that having a rejection does not mean that you will lose your new organ. Rejection is treatable when it is caught and treated in its early stages.
Treatment of Rejection
If you do have a rejection, your Prednisone dosage will be increased and then reduced to its previous level as follows:
Day 1: 100mg
Day 2: 100mg
Day 3: 100mg
Day 4: 90mg
Day 5: 80mg
Day 6: 70mg
Day 7: 60mg
Day 8: 50mg
Day 9: 40mg
Day 10: 30mg
Your Prednisone level will be kept at 30 mg per day until your doctor changes it.
If you have been discharged from the hospital and have rejection, you will generally not have to be readmitted for treatment of the rejection. We do ask, however, that you be extra careful about avoiding people with colds or flu during your treatment for rejection. You may be readmitted to the hospital if the rejection is severe.
As mentioned above, the only way to catch rejection of the transplanted heart is in its early stages, by performing frequent biopsies of your heart. The biopsy is done in the cardiac catherization lab. During the biopsy, a long tube (bioptome) is used to snip off a small piece of the right ventricle of your heart. This heart tissue is then removed from your body and examined under a microscope by a pathologist. The doctor can see if any immune cells are present in your heart and whether they are attacking your heart. Depending on how much damage the doctor sees, he/she will classify your biopsy as rejection free, mild rejection, or severe rejection. The biopsy specimen takes one day to process.
Most of the time the bioptome will be inserted through a small incision in the skin on the right side of your neck.
The biopsy usually takes about 30 minutes. After the biopsy is over, if a neck vein was used, you will be asked to keep your head up and not to bend over in order to keep bleeding from occurring at the biopsy site. If a groin vein was used, you will be asked to lie on a stretcher and to keep your leg straight for an hour to avoid bleeding. In either case, you will be observed for bleeding and gentle pressure will be applied to the biopsy site. Although these occur rarely, notify the nurse or doctor if you feel bleeding or swelling at the biopsy site. They will treat this by adding more pressure. Shortness of breath or unusual chest pain immediately after the biopsy may be signs of a complication and should be reported right away.
After your heart or heart-lung transplant, you will have a biopsy according to a schedule designed for you.
This schedule may be altered according to your progress and whenever rejection occurs. As stated before, patients having a single lung transplant will not require heart biopsies.
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