What to Expect When Transitioning from Pediatric to Adult Heart Transplant Program

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Eileen Hsich, MD:

Hi, I'm Dr. Eileen Hsich. I'm the medical director for heart transplant at the Cleveland Clinic, and I've been here for 20 years. We are so excited to meet you during this transition from pediatric to the adult transplant program. I know you must have lots of questions and lots of concerns. What is it going to be like? And I want to spend the next few minutes just making you feel more comfortable, so that you know what to expect.

We're a very large team. You're used to having maybe one or two heart transplant cardiologists and maybe one or two coordinators that provide that special care and that you have a very close relationship with. It's going to feel really different, but we have over 20 adult heart transplant cardiologists and multiple coordinators, as well as multiple social workers, pharmacists, a big team. The good part that you should remember is that, with such a large team, we're here to help you.

We have lots of resources, lots of ability to take care of you. We have excellent outcomes. They're actually top in the nation, so you're in good hands. I also want you to know that it's a large program. We have over 2000 heart transplant recipients, so we have a lot of experience and we're going to do a great job together as a team.

I think right up front, the very first thing that you're going to notice is that the waiting room is very big. You're going to be waiting with other patients that may not be heart transplant recipients. You will be greeted by a member of our team who will take your vitals, your heart rate, your blood pressure, and your weight, and bring you back into one of our transplant rooms. There you will meet a coordinator or the staff and sometimes both. If you're more than a few years out, so about four years, you only are going to be coming twice a year. So, that visit will be very special, but it will not be maybe the frequency that you're used to or maybe it will be.

I also want you to know that we do not routinely do biopsies. So, if you're more than four years out and more, and if you have not had rejection, then we will not be doing a biopsy. We'll be assessing how you're doing and making decisions based on that. If there's concern for rejection, then of course we will proceed with a biopsy. If a biopsy is done, we do not use sedation. So, that will be a big difference. But as I said, we do not routinely do it for patients who are four years or more, post-transplantation.

I think the other thing is that, we look for coronary artery disease annually and do not do left heart caths routinely. Most of the testing will be non-invasive stress tests. I want you to realize that we're not going to proceed with the left heart catheterization unless we need to. So, if the test is abnormal, the stress tests, then we are going to follow it up with the catheterization. Most of those catheterizations will be from the arm, as a procedure and you will receive sedation. That will be given to you. Not full sedation, you will not require actually being on a breathing tube or anything like that, but light sedation, so that it is really more comfortable and that we can focus on the vessels of your heart.

We are so excited to meet you and I look forward to actually seeing every one of you. Thanks.

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