Although the risk of anaesthesia in patients undergoing cardiac transplantation is high, anaesthesia-related morbidity and mortality is extremely low, if management is based on adequate organ-preserving therapy, adaptation of anaesthetic techniques to the deranged myocardial function that characterizes end-stage cardiac disease, prevention of aspiration, reduction of the immunosuppression-induced risk of infection and consideration of the consequences of heart denervation. Problems associated with anaesthesia for surgery on post-cardiac transplant patients include adverse effects of immunsuppressive agents, and the particularities of the denervated heart with regard to haemodynamics and drug response.