Transplant-related coronary artery disease is the main cause of death in orthotopic heart transplant recipients one year or more after operation. We report our own experience with chronic vascular rejection occurring 4, 10, and 15 months after transplantation in 3 of 71 consecutive patients. Immunosuppressive regimen included perioperative lymphocyte antibody therapy, cyclosporine, azathioprine and methylprednisolone. All 3 patients received cardiac allografts from donors not the same ABO blood type and developed cytomegalovirus infection (one primary phase infection and two reactivations). Death occurred in all of them. Histologic signs of both cellular and vascular rejection were found in one patient and two had pure vascular rejection. These observations support the potential role of cytomegalovirus infection and donor-recipient partial ABO blood type group incompatibility in the development of allograft vasculopathy as a short-term complication in heart transplant recipients.