**Abstract**

Heart transplantation is the treatment of choice for patients with refractory heart failure treatment. Although there were advances in medical therapy and immunological knowledge regarding rejection, it is one of the major limitations for long-term survival for those who were submitted to heart transplantation. In this chapter, the main issues of rejection and prevention in heart transplantation will be discussed.

**Keywords:** heart transplantation, rejection, prevention, coronary vasculopathy, cellular rejection
