Objective: To assess levels of and factors associated with depression and negative affect 5 years after heart transplant (HT). Participants: 370 adults 5 years post-HT. Outcome Measures: Cardiac Depression Scale and the Positive and Negative Affect Schedule (PANAS). Research Method: Stepwise multiple regression analyses were used to test 32 potential demographic, medical, functional, and psychosocial factors in adjustment. Results: Predictor variables accounted for 53% of the variance of depression scores and 45% of the variance of PANAS negative affect scores. The best predictors (p =.001) for depression were neurological symptoms, younger age, lower recreational functioning, and lower satisfaction with emotional support, and the best predictors for negative affect were neurological symptoms, lower mobility functioning, and perceived uncertainty about health. Depression scores were lower than norms for nontransplanted heart failure patients, and negative affect levels were comparable to those of the general population. Conclusions: The findings indicate normal long-term adjustment among HT recipients. Several factors associated with negative emotions, including younger age, have not been identified in previous research. © 2007 APA, all rights reserved.