A child’s pediatrician is part of the team for post -transplant heart care

When a pediatric heart transplant patient is well into postoperative recovery, their home pediatrician becomes a closer member of the transplant team with Norton Children’s Heart Institute, affiliated with the UofL School of Medicine.

When a pediatric heart transplant patient is well into postoperative recovery, their home pediatrician becomes a closer member of the transplant team with Norton Children’s Heart Institute, affiliated with the UofL School of Medicine.

Months after the transplant — and after the child has returned home, whether in Louisville or hours away in Kentucky or Southern Indiana — the local pediatrician is the first to spot whether otherwise routine health issues are transplant-related.

As part of the team, the local pediatrician gets briefed on the child’s condition and is prepared to watch for signs of rejection as well other symptoms that could signal heart failure. In addition, Norton Children’s Heart Institute cardiologists staff more than 15 clinics across Kentucky and Southern Indiana.

“We don’t expect the pediatrician to manage any of the nuances of the post-transplant care, but pediatricians know these children well and know what’s normal for them and what’s not,” said Sarah J. Wilkens, M.D., MPH, a pediatric heart failure and transplant cardiologist at Norton Children’s Heart Institute.

In the immediate post-transplant period, the transplant team at Norton Children’s Heart Institute sees these patients for regularly scheduled visits in clinic. It’s part of a structured protocol to monitor the patient when risk is highest. Cardiologists are watching for signs of rejection and a need to adjust medications.

A month or two after transplant, local pediatricians are at the child’s front line of care.

If a pediatrician is concerned about the child’s condition, a Norton Children’s Heart Institute transplant coordinator and heart care providers, including heart failure and transplant cardiologists, are available 24 hours a day, according to Dr. Wilkens.

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These children will get the same colds and viruses as other children. At the same time, according to Dr. Wilkens, they are at risk for rejection.

“Rejection can look like a lot of different things,” Dr. Wilkens said. “Nausea and vomiting that are not going away can be a sign of rejection. If the patient comes in with respiratory complaints or chest pain or swelling in their legs or belly, we worry about rejection.”

Immune-suppression medications put these children at risk for infection, meaning there is a lower threshold for a full workup when one of these transplant recipients presents with a fever.

Infections also can last longer in transplant patients. A cold that lasts a day or two in other children can take a week or longer to resolve in a transplant recipient.

In addition, pediatricians should check to make sure medicines they prescribe don’t interact with immune-suppression medications, according to Dr. Wilkens. Pediatricians are welcome to call Norton Children’s Heart Institute to check on possible medication interactions.

As more time passes from transplant, patients have fewer visits with the transplant team at Norton Children’s Heart Institute. After a year post-transplant, recipients have two follow-up visits and four labs a year.

Norton Children’s Heart Institute typically does about 10 transplants a year. The transplant team did six transplants in 2021, with patients ranging in age from 6 months to 18 years old.


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