**1. Introduction**

Heart transplantation has been the treatment of choice for patients with refractory heart failure or end-stage heart disease.

There are complications related to the heart transplant such as rejection, primary graft failure, cardiac allograft vasculopathy (CAV), and other complications due to the immunosuppressant drugs.

One of the major limitations to survival is still the rejection so prevention is the main challenge for those who take care of these patients after heart transplantation. In this chapter, the main issues of heart transplantation and prevention of rejection will be discussed.

The prevention of rejection starts when the recipient is evaluated for heart transplantation (pretransplant), during and after the procedure [1].
