The international experience has documented the therapeutic value of cardiac transplantation in the management of carefully selected patients with endstage heart disease. The UCLA program's experience over the years 1984 to 1990 mirrors these results, establishing heart transplantation as an accepted form of therapy that offers extended survival and improved quality of life compared to alternative means of treatment. Criteria of eligibility for recipient candidates have become less restrictive, most notably the expansion of age limits to include increasingly older patients. Seventy-three patients over 55 years of age underwent heart transplantation in this series, with actuarial survival results comparable to that achieved in adult patients 55 years of age and under (68.5% vs 74.7% at 4 years, respectively). Twenty-one children between the ages of 7 months and 17 years have undergone cardiac transplantation at UCLA with survival results comparable to that of our adult population (74.3% vs 76.5% actuarial survival at 3 years, respectively). Continued efforts aimed at the development of improved means of immunosuppression as well as better methods for the detection of rejection are needed if these results are to be significantly improved.