P-31 nuclear magnetic resonance (NMR) spectroscopy was used to evaluate heterotropic cardiac allograft rejection in the rat. To enable optimal application of NMR spectroscopy for the in vivo study of myocardial metabolism in the transplanted organ, an accessory heart transplantation to groin in the rat was used. The allografts were studied in a 1.89 Tesla horizontal bore magnet. Each spectrum was obtained by Fourier transform of 512 scans using 60-degree pulses with 2-sec delays. Changes in phosphocreatine (PCr), adenosine 5-triphosphate (ATP), and inorganic phosphate (Pi) and intracellular pH as determined by P-31 NMR were compared with rejection process as judged by histological studies. Allografts treated with cyclosporine (CsA) did not show any rejection (NR) and had relatively high levels of PCr, and low levels of Pi. Allografts that did not receive any CsA revealed both vascular and cellular rejection. These rejected allografts (R) had relatively low levels of PCr and high levels of Pi. It is concluded that P-31 NMR spectroscopy may have potential application to the clinical diagnosis of cardiac allograft rejection.