After Your Heart Transplant

Step Four: Taking Care of Your New Heart

After heart transplant surgery, you’ll need time to adjust to life with your new heart. Life after transplant requires a commitment to staying healthy. This means taking your medications according to schedule, coming to all follow-up appointments, and maintaining healthy habits. We want you to achieve the best possible outcome after heart transplantation.

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Follow-Up Care After Heart Transplant Surgery

For the first four weeks after surgery, you will come to Duke for testing and follow-up care once a week. You will not be able to drive for six weeks after surgery, so your caregiver will need to bring you to these appointments. If you don’t live close to Duke, you may want to find temporary lodging nearby during this time. Your transplant coordinator can help you make these arrangements.

At every follow-up visit, you will meet with members of your transplant team and undergo testing to see how well you’re healing, monitor any medication side effects, and look for signs of rejection. Over time, these visits will occur less often, but you will still need to return to Duke for follow-up appointments -- in most cases every six to twelve months. You can also follow up with your local cardiologist if you live far away from Duke.

Typical Follow-Up Schedule

Time After Transplant	Frequency of Follow-Up Visits
Month 1	Weekly for 4 weeks
Month 2	Every other week
Months 3-6	Every month
Months 8-12	Every other month
Year 2	Every 3 months
Year 3 and beyond	Every 6 months

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Preventing Heart Transplant Rejection

Rejection happens when your body’s immune system detects that the cells in your new heart are not exactly like those in the rest of your body, and it begins attacking the new heart. The risk of rejection is highest in the weeks just after transplant. However, because it can occur any time, you will need to take immunosuppression drugs for the rest of your life. To help lower the risk of rejection, your transplant team will carefully monitor your health and adjust your medications as needed.

During your regular checkups, your doctor will look for signs of rejection that may include swelling of your feet, hands, or ankles and feeling tired and weak. Many times, though, rejection occurs with no symptoms at all and that is why your doctors will evaluate your condition with biopsies and blood tests. Rejection episodes are common for transplant recipients. In most cases, especially if detected early, they can be treated by increasing the dose of your anti-rejection medication or with high-dose steroids.

Request a Referral from Your Doctor

If you are interested in making an appointment for an evaluation, please ask your cardiologist to submit a referral.

Regular Testing

To check for rejection, infections, and problems with heart function at your follow-up appointments, you will have one or more of the of the following tests.

Blood Tests

Blood tests given after transplant surgery measure cholesterol levels, blood cell counts, levels of prescribed drugs in your blood, and more.

Echocardiogram

Also called an echo, this test uses sound waves (ultrasound) to create moving images of the heart. This allows your doctor to assess your heart’s structure and function.

Chest X-Ray

Images of your heart and blood vessels can reveal signs of heart disease.

Heart Biopsy

During a heart biopsy, your doctor will numb an area of your skin and insert a thin tube (called a catheter) into a vein in your neck. The catheter will be threaded down to your heart, and a small sample of tissue will be removed and examined with a microscope. This procedure takes about 30 minutes.

Heart Catheterization

Nearly half of heart transplant recipients develop coronary artery vasculopathy (CAV) within 10 years of transplant. CAV occurs when the blood vessels of your transplanted heart narrow and restrict blood flow. To check for CAV, one year after your transplant surgery, you will have a coronary angiogram (cardiac catheterization). For this procedure, your doctor will numb an area of your skin and insert a catheter into an artery in your groin or arm. The catheter is threaded through blood vessels to your heart. Your doctor will check for blocked or narrowed blood vessels in your heart. Depending on your test results, this test may be repeated every year. Taking your prescribed medicines and managing your blood pressure, cholesterol, and weight can help lower your risk of developing CAV.

Our Locations

Heart transplant surgery is performed at Duke University Hospital. Pre- and post-transplant appointments take place at our cardiology clinics in Durham.

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Cardiac Rehabilitation

Cardiac rehabilitation is recommended for all heart transplant recipients beginning six to eight weeks after transplant surgery to help you build strength, improve mobility, and speed recovery. Most programs last 12 weeks and include medically supervised exercise, nutrition counseling, health education, and psychological support. Your transplant coordinator can help you locate a program at Duke or at another facility close to your home.

Healthy Habits After Heart Transplant Surgery

You play an important role in maintaining the health of your new heart. Staying alert to changes in your health and following the recommendations of your transplant team can help you make the most of life after transplant surgery.

Medications

In addition to lifelong immunosuppression drugs, you may need to take other types of medications. For instance, you may take medicines to help you avoid infections or to reduce the risk and severity of coronary artery vasculopathy.

Monitoring Vital Signs

To help your transplant team track your progress and adjust your medications, you will be asked to record your weight and vital signs and bring these records to your follow-up appointments. Changes in blood pressure, heart rate (pulse), temperature, and fluid status (weight) may indicate a need for medical attention.

Honoring Your Pre-Transplant Commitment

Smoking or using tobacco products can cause heart damage. Alcohol may interfere with your anti-rejection medications and can harm your kidneys and liver. Honor your pre-transplant commitment to care for your new heart by avoiding tobacco and limiting alcohol. We offer smoking and tobacco cessation programs to help you stay healthy.

Avoiding Infection

While your immunosuppression medications help your body accept your new heart, they also increase the risk for infections, such as a cold, the flu, or other viral illnesses. This risk is greatest when you are on high doses of medication -- usually the first six to twelve months after your transplant or during an episode of rejection when your dose is increased. You can lower your risk for infection by consistently washing your hands, avoiding people who are sick, and getting vaccines as recommend by your doctor.

Seeking Support

As a Duke heart transplant recipient, you are our patient for life. We can provide you and your caregivers the resources and support you need -- right after surgery and in the years to come. Our transplant coordinators are always available to answer any questions and address your concerns. They can also connect you to other donor heart recipients at Duke.

Best Heart Hospital in North Carolina

When it comes to your heart care, you want the very best. Duke University Hospital is proud of our team and the exceptional care they provide. They are why our cardiology and heart surgery program is nationally ranked and the highest-ranked program in North Carolina, according to U.S. News & World Report for 2025–2026.

This page was medically reviewed on 01/24/2023 by

Joseph B. Lerman, MD | Advanced Heart Failure Specialist