Heart transplantation is now an accepted method for ireatment of riaart disease in children, but transplantation In pediatric recipients continues to present unique challenges. The differences in indications and ttie complexity of surgery for congenital heart disease are only two of those challenges, A successful means of mechanical support is not available, which puts children at special risk of dying while waiting tor transplantation. In addition, physiologic differences produce issues aboul management after transplantation, including use of immunosuppressive agents, control of infection, identification of transplant coronary artery disease, and posttransplant lymphoproliferativie disease. Because of the longer life expectancy desired from pedialfic transplantation, measurement of quality of life must be mare comprehensive. This broad range of special demands means that although the state of pediatric heart transplantation Is positive, there are areas for continued improvement.