The inflammatory cell infiltrates in 15 endomyocardial biopsies serially obtained from a human cardiac allograft during a 1 1/2-year period were characterized. An indirect immunofluorescent technique with hybridoma-derived monoclonal antibodies which preferentially react with B lymphocytes (anti-Ia), mature T cells (OKT3, Leu 1), and helper (OKT4b,d) and supressor/cytotoxic (OKT8) T-cell subsets and with natural killer cells, macrophages, and granulocytes (OKM1) was used. During each of seven rejection episodes the overwhelming majority of infiltrating cells in the endomyocardial biopsy were OKM1+Ia. These cells displayed short microvilli, a moderate amount of cytoplasm, numerous mitochondria, a large amount of rough endoplasmic reticulum, Golgi, and an indented nucleus, that is, the ultrastructural features of large, granular lymphocytes. Thus, they morphologically and phenotypically resemble those lymphoid cells which have been shown to possess natural killer (NK) functions in man. Occasional Leu 1+OKT3+ cells, some of which were OKT8+, were also seen during acute rejection. In each instance following therapy and resolution of the rejection episode only rare OKM1+Ia- cells were present. At this time the majority of the cells were Leu 1+OKT3+OKT8+. Routine biopsies, performed at times without evidence of rejection, showed only reactivity for Ia antigens by the capillary endothelium. These studies demonstrate the prevalence of cells with the natural killer phenotype in this human cardiac allograft during episodes of acute graft rejection.