The 1-year survival rates following heart transplantation have improved from 30% in the 1970s to nearly 90% in the 2000s. However, due to chronic rejection, malignancy, and the side effects of chronic immunosuppression, there has been little improvement in long term outcomes (Tonsho et al., 2014). Survival rates for recipients who underwent heart transplantation from 2008–2010 was 89.6%, 82.9%, and 77% at 1, 3, and 5 years (Colvin et al., 2017).

The leading causes of death in the first-year post heart transplantation were infection, cardiovascular/cerebrovascular disease, and graft failure. The incidence of acute rejection in the first-year post transplantation was 23.0% in 2013–2014 (Colvin et al., 2017).

In subsequent years cardiovascular/cerebrovascular disease was the most common cause of death. Death due to malignancy (which is associated with a cumulative exposure to immunosuppression) was relatively rare, with 1.7% of recipients dying from malignancy by year 5 (Colvin et al., 2017).

In combined heart and kidney transplant recipients, the most identifiable causes of death during the first 30 days were graft failure (lung or heart) (27%), technical complications (22%), and non-cytomegalovirus (CMV) infections (17%), with no mortality due to CMV within this period (Yusen et al., 2015).