Pediatric heart transplantation at Loma Linda is now in its second decade with 299 infants and children having received 309 transplant procedures. Overall survival is 73% with 10 year actuarial survival of 66% for all ages. Newborn recipients have a 77% actuarial survival at 11 years. As expected, acute rejection, infectious disease and technical issues are the most frequent causes of death. Posttransplant coronary artery disease (PTCAD) has been diagnosed in 22 patients, an incidence of 9.5% of those patients surviving at least 1 year after transplantation. Seven children have undergone retransplantation for PTCAD with an actuarial survival at 3 years of 83%. Six children (2%) have been diagnosed with posttransplant lymphoproliferative disease. Long-term renal function is acceptable with average glomerular filtration rate of 79 ml/min/1.73 m2 and average creatinine beyond 5 years of 65 mmol/l (0.7 mg/dl). Most children in this population have heights and weights within the low normal range. Infant recipients who are now at least 6 years old are in an appropriate grade level in 85% of cases. Ten year survival, with good clinical outcome, is achievable in this population.