Post-operative medication considerations in cardiac transplant patients

The first successful heart transplant was carried out in 1979, and there are now approximately 200 transplants undertaken in the UK each year. Many medications are used to prevent rejection of the transplanted organ, but this needs to be balanced with the risk of complications of immunosuppression, such as infection, organ dysfunction, graft dysfunction and vasculopathy. Patients must be able to adhere to the complex and vast regimen of medications started post-transplant, and extensive monitoring is required to ensure the correct balance of rejection risk and adverse effects, depending on where the patient is in their postoperative journey. Immediately after the transplant is when the patient is at highest risk of rejecting their new heart. Guidance is available to recommend regimens to prevent rejection, but needs to be adapted to each patient, taking into consideration their clinical picture, together with comorbidities, drug interactions and organ dysfunction.