Heart transplantation gives patients a second chance at life. People who undergo a heart transplant can return to their normal lives and even their jobs after a few months. However, in this second life, patients must protect their transplanted organs and overall health with greater care. If they take care of their new hearts, they will enjoy a healthy and better quality of life for many years.
The body perceives transplanted organs as foreign objects and goes on the attack. Cells of the complex system we call the immune system want to attack and damage the tissues of the transplanted organ—connected to the body’s circulatory system—just as they would attack any virus or bacteria entering the body that causes a cold. We call this attack of immune cells on the new heart rejection. This event, called rejection, is usually seen within a few weeks following the organ transplant. However, such a reaction can be encountered months or even years later. For this reason, organ transplant patients must take these anti-rejection (immunosuppressive) medications for the rest of their lives. The success of organ transplants depends on patients following the doctor’s advice and using these medications at the recommended dose and time, without ever skipping them.
To reduce your body’s reaction to the transplanted organ: You must take your medications in accordance with your doctor’s recommendations. Your immunosuppressive medications, which are very important for you to prevent the body from reacting to your new heart, are:
- Sandimmun-Neoral (Cyclosporine-A) or Imuran or Prograf (Tacrolimus)
- Cell-cept (Mycophenolate Mofetil) or Myfortic
- Deltacortil (Prednisolone)
Your other medications are also important and should be taken on time. Never neglect taking your medicine and do not change the dose yourself. Try to take your medicine at the same time every day. Drink your medicine with plenty of water (at least one full glass). Your physician may prescribe additional medications in addition to the ones above.
If you forget to take your medicine, take it as soon as you remember. If you are very close to the time of your next dose, do not take the forgotten dose and do not change your normal dose and medication time. When it is necessary to stop any medication you are taking upon your doctor’s advice, examine the interaction it will have with immunosuppressive drugs.
Adjust your medication stocks, taking into account holidays and travels you will make. Investigate the interactions of any medications you take without a doctor’s recommendation with anti-rejection drugs; if possible, do not take a new medication without consulting your doctor. Definitely stay away from “folk remedies” (Lokman Hekim medicines)!!!!!!!!
You should not drink your medications with grapefruit juice. Grapefruit juice can change the effects of your medications and cause negative results (especially increasing the effects of Cyclosporine, antihistamines, and cholesterol-lowering drugs). Be sure to inform any new doctor during visits that you have had an organ transplant. If new side effects occur or if there is an infection, be sure to inform your doctor.
In Case of Rejection: Even if the anti-rejection drugs mentioned above (Cyclosporine, Prograf, Imuran, Cell-Cept/Myfortic, Prednisone/Deltacortil) are taken regularly, immune cells may sometimes attack the new heart. Almost all patients may experience one or more rejections. In this case, medications for this are started without wasting time. While the rejection gradually passes after a while, treatment is continued by reducing the dosage. As a result, you must take anti-rejection drugs continuously for the rest of your life. Dosages may decrease, but they should never be skipped or stopped. Rejection may be seen more frequently within the first six weeks after surgery. The probability decreases in later times, but it can happen at any moment in the future. For this, it is necessary to continue periodic check-ups without interruption. In case of rejection, the only way to detect it at an early stage before your immune system damages your new heart is to be under frequent control. Your doctors diagnose whether rejection is occurring through frequent examinations in the first stage, blood tests, echocardiograms (ECHO), and biopsies. In later years, the interval between control times may be extended.
Infections: Since the medications that prevent your immune cells from attacking your new heart also prevent attacks on harmful organisms such as bacteria, viruses, parasites, and fungi that enter the body and circulatory system, the patient’s body remains unprotected. This risk is higher when high doses of medication are taken during rejection periods. After surgery and in cases of rejection, the patient must be cared for under sterile conditions with maximum hygiene provided.
Other diseases that may occur due to the continuous use of anti-rejection drugs:
- High Blood Pressure: Should be monitored constantly. If necessary, your doctor can prescribe blood pressure-lowering medication. If high blood pressure is not monitored and controlled, it can damage the kidneys, heart, vascular system, and brain. It can cause strokes and heart attacks.
- Diabetes: Your blood sugar may rise due to medications. Particular attention should be paid to nutrition.
- High Cholesterol: Prevented by giving a prescription to control cholesterol.
- Cancer: Although the frequency has decreased with the use of new-generation drugs, certain types of cancer (such as Lymphoma and skin cancers) may appear. This is prevented by the doctor reducing drug doses.
- Osteoporosis: This disease is the thinning of the bones due to poor nutrition, inactivity, prednisone, and other anti-rejection drugs; it can be diagnosed with tests.
- Vision: In case of visual impairment, go to an ophthalmologist for cataract and glaucoma tests.
- Kidney Diseases: Kidney functions should be monitored by performing regular blood and urine tests. As a precaution, the drug level is reduced. Damage is prevented by drinking plenty of water.
Vitamins, minerals, antibiotics, and antiviral drugs:
- Bactrim (Trimethoprim-Sulfamethoxazole): Prevents Pneumocystis carinii pneumonia, which is common in patients receiving immunosuppressive drugs. Some side effects may be seen; it can interact with Cyclosporine and lower its blood level. Although rare, it can cause nausea and vomiting. For those with allergies, your physician may give other medications instead of this drug until the 6th month.
- Valtrex: Used in the prevention of viral infections such as Cytomegalovirus (CMV), Herpes Zoster, and Herpes Simplex that can be seen after organ transplantation.
- Mycostatin: Prevents fungal infections in the mouth while taking high doses of immunosuppressive drugs. Gargle 5cc in the mouth 4 times a day and swallow. It can be discontinued by your doctor’s decision when Prednisolone (Deltacortil) drops to the required level.
- Folic Acid: Works with iron to increase the red blood cell count. An iron compound that interacts with folic acid. Iron and folic acid help increase red blood cells by providing the nutrients necessary for your body. After surgery, iron is only given until the blood value returns to normal. Side Effect: Constipation.
- Omeprol (Omeprazole) 20mg: Used as a stomach protector against intensive medication use.
Inform your doctor in the following situations:
- High fever over 37.5°C lasting for a long time.
- Fatigue, tiring easily, shortness of breath, persistently high blood pressure.
- Rapid weight gain within one or two days.
- Fluid accumulation in tissues (edema).
- Heart rhythm disorder.
- Fainting for unknown reasons.
- Diarrhea lasting more than one day, bloody diarrhea.
- Constipation lasting more than two days.
What will your lifestyle be like? Rest plenty in the first weeks and months. At least half an hour of rest is required after meals. Walks should not be immediately after meals. Organ transplantation can enable you to return to a normal life. After experiencing health problems for a long time, you need to pay importance to your health in your new life that will come with organ transplantation. This issue is quite important because after organ transplants, you must protect your new heart and health well so as not to experience the health problems you had before the transplant again.
Nutrition: Before being discharged, visit the diet department in our hospital, get your diet program suitable for your weight, height, and age from our dietitians, and follow the given diet exactly (Especially reduce salt, sugar, and carbohydrate foods). You will probably feel your appetite increasing after the organ transplant, especially if your illness lasted for a long time before the transplant. Healthy nutrition is part of your treatment in your recovery process after organ transplantation. Since some anti-rejection drugs will increase your appetite significantly, you may gain weight quickly after transplantation. In such a case, inform your doctor, and they can readjust your medication doses. It is recommended that you eat with conscious nutrition and a low-fat, low-sugar, fiber-intensive diet. You can also ask your doctor questions about your nutrition. It is recommended to weigh yourself once a week after surgery. Blood pressure monitoring should be done once a day. You should reduce salt consumption because it can raise your blood pressure. As in every subject, you must follow your doctor’s advice on nutrition. Avoid one-sided nutrition. Salted, smoked, dried meats and foods, canned, and frozen foods should not be eaten. Meat, milk, chicken, turkey, fish, and dairy products should be taken fresh and daily. Care should be taken that your food and drinks are fresh, clean, prepared in accordance with hygiene rules, and well-cooked (especially meats should be well-cooked). Prepared meals should be consumed daily. They should not be stale, spoiled, or molded. Prefer vacuum-packed food items if possible.
Restrictions to be made:
- Fluid and salt restriction.
- Foods with high Na+ (sodium) content.
- Restriction in protein intake.
- Calorie restriction.
- Concentrated carbohydrate restriction.
- Cholesterol and fat restriction.
- Caffeine restriction.
- Restriction of brain, offal, dried fruits, sugary foods, chocolate, cream, floury foods, etc.
- Alcohol restriction.
Fluid and salt restriction: Since Prednisolone intake keeps salt and fluid in the body, salt should be used in a controlled manner. Salt causes excess water retention in the body, arteries, and veins. To avoid this, you should reduce both. To get fluid, eat fruit instead of fruit juice. Your doctor can prescribe salt restriction. Foods with high sodium content: Ready-made sauces, instant soups, canned foods, tomato paste, salty cheeses, frozen peas, salted fish, anchovies, meat products such as soujouk, pastrami, sausage, salami, salted or unsalted nuts, tarhana soup, ketchups, biscuits, crackers, salty galettes, salty butters, all kinds of ready-made foods and ready-made drinks, salty bread, pita, crackers, corn bread, chips, pickles, mayonnaises, and spicy foods.
Protein intake: High-protein foods can be given for a short time for the healing of wounds after surgery. However, the amount of protein given can be changed depending on the functioning of the kidneys. There is no need for a protein-rich diet after surgical wounds heal.
Calorie restriction: The total calories you take should be adjusted by dietitians for reasons such as maintaining, increasing, or decreasing your weight. Excessive weight increases the workload of the heart. Medication treatment can cause excessive eating and weight gain. Therefore, you should pay attention to the total calories you take. Excessive weight also causes fat in the blood. This lubrication causes the blood vessels in your heart to narrow and become blocked. The calorie value of the total amount of fat you take daily should not be more than 30% of the calories you need daily.
The following points are very important to ensure food hygiene: The person who will prepare the meals should wash their hands thoroughly with liquid soap before starting to cook. When you take the product you store in the refrigerator out of its vacuum-packed packaging, keep it in a storage container with a glass lid. Wash your vegetables and fruits with plenty of water in the washing bowl. You can rinse the vegetables and fruits you will consume raw by adding 5% vinegar to the final water. Kitchen utensils such as pots, forks, spoons, knives, glasses, plates, and bowls should be washed in the dishwasher at a high temperature setting if possible. The person receiving treatment should always eat and drink from their own special glasses, dishes, and plates.
Sports and exercise: Gaining strength for your body after heart transplant surgery is one of the most important parts of your recovery process. Continue the daily exercises performed by physiotherapists in the hospital in the morning and evening. Be sure to consult your doctor about what level of sports you can do after the transplant surgery and how to start. Make a regular sports plan and follow it without interruption. When doing sports, remember that your body has weakened due to the long-term illness you have had, and it will take time to regain its former strength. Walking will be a good option to start with. Walks should not be immediately after meals. You can walk for sports purposes after resting for at least two hours. You should not overdo it while doing sports. If you feel pain in your chest, a sudden shortness of breath, dizziness, or an irregularity in your heartbeat, be sure to consult your doctor. You can sleep at least four hours after eating dinner.
Smoking and alcohol: If you use cigarettes or alcoholic beverages, you must quit smoking and drinking after the organ transplant. If you use cigarettes and alcoholic beverages, your risk of heart disease and the damage it will cause to other organs will increase due to medication use. This situation will cause treatment failure or even rejection.
Ways to Avoid Infection: Since anti-rejection drugs reduce the body’s immune system, organ transplant patients become sensitive to bacteria and microbes. To reduce the risk of catching a disease, hygiene should be given great importance. Hands should be washed frequently. You must wash your hands before and after meals. Hands and feet should be checked frequently to prevent fungus formation. Underwear and towels should be changed every day. Underwear should be washed in an automatic machine with high-degree hot water.
Dental and oral health: Teeth should be brushed after every meal with a soft toothbrush and a toothpaste providing full protection. Then, it should be rinsed with a mouthwash containing nystatin (Mycostatin) (this mouthwash should be used for the first 6 months after the operation). You should use antibiotic medication before treatments that are not superficial, such as tooth extraction or root canal treatment.
Pets: If possible, do not keep pets in your home. Be sure to wash your hands after contact. Keep your pets’ feeding bowls and places away from the area where you eat. Use gloves during pet cleaning and avoid contact with birds and poultry.
Travel: If your doctor has no objection after the surgery, there is no harm in traveling. However, there are some points you should pay attention to, especially on your international travels:
- Avoid going to countries where there is dirty water and food and where treatment systems are lacking.
- Avoid drinking tap water, ice, shellfish, unpeeled foods, and undercooked meats in places where you doubt hygiene.
- Make sure you take enough medication to last for your travel. It may be difficult to obtain your medicine in some countries.
- Take your medications with you, considering the risk of your luggage getting lost.
- It is highly recommended to get vaccinated before traveling to some countries. You can obtain a list of vaccines that are safe to use from your organ transplant center.
- Your doctor may want you to get a flu shot every year. (Do not get a live virus vaccine).
- It is necessary to have malaria medication with you when traveling to countries where malaria is intense. Consult your doctor for a suitable malaria medication you can safely take.
Sun protection: You can take some simple precautions to protect yourself from the sun:
- You can use sunscreens with high protective properties. You can take precautions by oiling your organs that are most exposed to the sun, such as your face, neck, ears, and hands, several times a day.
- Do not stand in sunny places and do not walk in the sun between 10:00 and 15:00.
- If you have to stand under the sun for a long time, wear long-sleeved shirts, pants, and a hat.
- If you have different formations on your skin that change, color change, or if an existing nevus (mole) suddenly grows or takes a different shape, consult a specialist physician.
MISTAKES MADE BY HEART TRANSPLANT PATIENTS
Patients must receive psychological support, and if medication has been given by doctors, they should use it without interruption.
Not taking their medications on time (30 minutes or later).
If the patient does not tell their doctor that they have reached more weight than the weight at the time of the first operation, they will have taken the medicine in incomplete doses since the drug dose is calculated according to the weight.
The patient will not change or stop any of their medications without telling their doctor. If another additional medication has been given by other doctors (due to another disease), they will definitely inform their own doctor and have the drug interactions checked.
When going to the doctor for periodic check-ups, the patient must take the follow-up chart and medications with them.
Since patients do not visit the diet department when they are discharged, they go home without getting their diet programs. They make some mistakes as a result of wrong nutrition. They do not pay attention to salt, cholesterol, sugar, overfeeding, and the prohibitions set by the dietitian. The issue of getting the diet program should not be left to the initiative of the patient (or their relatives); they should be visited in the room by dietitians the day before discharge and delivered against a signature.
In case of acute rejection, the patient should apply a salt-free diet and be more careful about food hygiene, general cleaning conditions, and infections.
Patients should be ensured to apply the exercise programs given by physical therapy specialists during the rehabilitation period, and the importance of this should be explained to them.
Relatives should be warned so that they can stay away from stress. They should be reminded to avoid behaviors that will cause stress to the patient.
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