From ICU Discharge to Hospital Discharge

Transition from the intensive care unit (ICU) to a medical surgical floor indicates the achievement of substantial hemodynamic stability and a shift in focus to optimizing immunosuppression with an eye toward discharge. Duration of the ICU stay will determine the extent of care needed. This chapter focuses on transplant recipients who follow an uncomplicated early postoperative course, and the steps required before the patient may safely transition to home or rehabilitation. It discusses the optimization of immunosuppression, monitoring and treatment for allograft rejection, management of arrhythmias, standard prophylaxis against common opportunistic infections, treatment of infectious diseases and comorbidities, and discharge from the hospital. Transplant vasculopathy remains a major long-term complication of heart transplantation, with an annual incidence rate of 5-10%. It remains one of the main causes of death in long-term patients after heart transplantation.