Studies from a number of centers have documented the growth and success of pediatric heart transplantation. The 1st year of life is the period of greatest mortality from congenital heart disease and has now become the single most frequent age of pediatric heart transplantation. Appropriately, congenital heart disease is the most common diagnosis leading to heart transplantation. Early mortality is still greatest in recipients who undergo transplantation during the 1st year of life. The patients at greatest risk are being identified and new maneuvers to lower early mortality are emerging. Long-term follow-up continues to indicate excellent late survival with low morbidity. This review focuses on key advances in knowledge reported in the last year.