Fifty-four human-to-human cardiac transplants (10 orthotopic and 44 heterotopic) in 50 patients were performed between December, 1967, and December, 1981. The underlying cardiac pathology was ischemic (IHD) in 29, cardiomyopathic (CM) in 17, rheumatic (RHD) in four, and mixed or other pathology in four. Patients with RHD survived for a mean period over three times as long as those with either CM (p < 0.02) or IHD (p < 0.05). Although CM patients were on average over a decade younger than those in other groups, they had a lower survival rate. There was a higher incidence of death from chronic rejection in patients with IHD, in whom there was also a higher incidence of thromboembolic episodes. Major infections were over twice as frequent in IHD patients as in CM patients (p < 0.01). Noncompliance with regard to adherence to instructions and therapy was a significant factor in morbidity and mortality, especially in CM patients. Our data suggest that survival and morbidity of recipients of heart transplants might be influenced to some extent by the nature of the underlying primary cardiac condition, RHD being considered a favorable survival factor when compared with IHD, and CM being particularly unfavorable. © 1984.