Long-term follow-up and complications after cardiac transplantation.

Cardiac transplantation has become an established therapy for cardiomyopathy and other irreversible cardiac diseases. Improvements in immunosuppression and management of infections has improved long-term survival following transplantation. The role of the primary care physician in the care of recipients will be expanding. Transplant recipients receive close outpatient follow-up after discharge, primarily to monitor immunosuppression through laboratory evaluation and drug levels, monitor for rejection through endomyocardial biopsy, and to assess for any signs of opportunistic infection. The foundation for long-term immunosuppression is administration of cyclosporin, azathioprine and corticosteroids. Antibiotic prophylaxis is used to decrease the chance of infection with cytomegalovirus, Pneumocystis, Candida, Toxoplasma, and other opportunistic organisms. The major long-term complications include rejection, infection, hypertension, renal dysfunction, lipid abnormalities, and accelerated coronary atherosclerosis. This review provides an overview of the short- and long-term follow-up of the cardiac transplant recipient, including routine care as well as detection and management of the common complications.