The International Society of Heart Transplantation Registry has now received data on almost 12,000 transplants including over 11,000 heart transplants and almost 600 heart-lung and 100 lung transplants. Recently, a plateau in number of transplants per year has become evident. It appears that further growth is now limited by donor supply. Operative mortality and long-term survival rates continue to show gradual improvement. Organ preservation and other intraoperative complications remain a major factor associated with operative mortality, especially in heart-lung and lung transplantation. Infection and rejection remain the most common causes of early and late deaths. An increasing number of patients have now received second transplants. At the present time, results with retransplantation are significantly worse than for the initial transplant.