This is a report of ten consecutive patients with end-stage cardiac disease treated with orthotopic cardiac transplantation in a community hospital, during the first year of its heart transplantation program. All patients were followed for a minimum of 33 months and a maximum of 45 months with 100% survival at two years and 90% at three years. All survivors are presently in N.Y.H.A. Class I or II. The entire group of patients received the same triple immunosuppressive therapy. The incidence of infection and rejection during the first three months post-transplantation was 0.3 and 0.6 episodes per patient respectively. Every patient developed some degree of deterioration in renal function and 80% of the patients now receive treatment for systemic hypertension. The in-hospital institution cost for the transplant admission varied from $25,084 to $74,164. To date, 30 patients have undergone heart transplantation in our program and 26 are long-term successes. This study again proves that renal insufficiency and hypertension remain the major side effects of Cyclosporine therapy. We further conclude from our experience that cardiac transplantation can be successfully and cost effectively performed in a community hospital even with a somewhat lower caseload.