For patients with end-stage heart failure, cardiac transplantation has become a promising therapy especially with the advent of immunosuppressive therapy and more careful screening of donor hearts. The survival of patients after cardiac transplantation has increased considerably. Many centers now have 1-year survival rates exceeding 80-90 per cent, and 5-year survival rates above 70 per cent. Infections, hypertension, and renal dysfunction caused by cyclosporine, rapidly progressive coronary atherosclerosis, and immunosuppressant-related cancers have been the major complications. The high cost and limited number of donor organs require careful patient selection early in the course.