Background: Cardiac transplantation is a therapeutic option in end-stage heart failure. Peripheral nervous system (PNS) disease is known to occur in cardiac transplant recipients but has not been fully characterized. Methods: This retrospective cohort review reports the PNS-related concerns of 313 cardiac transplant recipients (28% women, 8% children) over an 18-year period at a single institution. Results: Thirty percent of patients (95 of 313) reported a PNS-related concern in the post-transplant period, but only 5% had a concern in the first 6 weeks after transplant. The relative frequency of PNS-related complaints was as follows: polyneuropathy, 33%; muscle disease, 26%; mononeuropathy, 17%; radiculopathy, 13%; small-fiber polyneuropathy, 4%; plexopathy, 3%; and other (e.g., herpes zoster), 4%. Conclusions: Etiology of these concerns can be divided into four broad categories: (1) immediate post-operative complications (e.g., brachial plexus stretch injury); (2) concerns related to the underlying disease prompting transplantation (e.g., polyneuropathy secondary to amyloidosis); (3) concerns related to necessary medications (e.g., steroid-associated myopathy); and (4) concerns reflective of aging in a post-transplant population with enhanced survival (e.g., degenerative joint disease-related radiculopathy). © 2009 International Society for Heart and Lung Transplantation.