The aim of this thesis is to describe the continued efforts to optimize patient care by ongoing analysis of various problems which currently predominate in bean transplantation. Chapters l-ID describe our research in heart transplant candidates and in subsequent chapters specific problems of the transplant recipient are addressed. Attempts to reduce the incidence of rejection are described in Chapters IV and V. The problems of coronaty vascular disease in the allograft and the angiographic findings in our patients are summarized in Chapters VI, VII and VID. The complications of immunosuppressive therapy are subject of Chapters IX, X and XI.Finally, the results in the first 200 heart transplant recipients of the Rotterdam Hea.rt Transplant Program are presented in Chapter XII.