Since 1989, 427 heart transplants were performed at our center, limited only by donor availability, not by moderating donor criteria. Therefore, an increasing number of possible recipients was bridged with mechanical circulatory support systems. Immunosuppression was based on double-drug therapy (CsA, Aza) without steroid maintenance if possible and without mono- or polyclonal antibody prophylaxis. Monitoring adult transplant patients was based on endomyocardial biopsies only during the first 12 months posttransplant. In the pediatric group, only noninvasive diagnostic procedures were performed. Our present 1- and 3-year survival rates for heart transplant patients are 85% and 78%, respectively. We believe that only centers performing approximately 1,000 routine open-heart surgery procedures per year should be allowed to perform heart transplantation, with a minimum of 25 procedures per year (5). Our goal is to start our heart-lung and lung transplant programs in the near future. Our research interests are mainly in the field of postoperative monitoring, induction of immune tolerance, and in establishing a method to determine an individual immunosuppression protocol for each patient (6).