Heart transplantation has excellent long-term survival, with 50% of patients living 10 years, and significant improvement in quality of life. Various factors contribute to increased early graft failure and morality, including changing donor and recipient profiles in recent years. Changes in recent years that have improved very long-term survival include modern immunosuppression, statin use, systematic post-transplant care/surveillance, and better management of renal dysfunction. The long-term complications following heart transplantation are similar to those of other organ transplants and include vasculopathy and complications of immunosuppressants. Coronary artery vasculopathy (CAV) is a leading cause of graft failure. The incidences of various metabolic syndrome risk factors including hypertension, obesity, diabetes mellitus, and hyperlipidemia are increasingly seen after heart transplantation. Acute and chronic renal failures are common after heart transplantation. Malignancy is a major cause of late morbidity and mortality after heart transplantation. Involvement of psychological and psychiatric support is important following heart transplantation.