End-stage heart failure is a leading cause of death in developed countries. Cardiac transplantation is the most effective treatment for heart failure refractory to medical or surgical therapy. This article analyses the first clinical experience in orthotopic heart transplantation in Ukraine during period 2001–2009. Four orthotopic heart transplantations were performed. The idiopathic dilated cardiomyopathy was the case of end-stage heart failure in three patients and the ischemic cardiomyopathy was the case in one patient. Follow-up period ranged from 6 months up to 33 months. All patients were males, the mean age was 32.7 yrs. All four patients were in III class of NYHA. Three-component therapy (cyclosporine A, methylprednisolone, azathioprine) was applied for immunosuppression. The most common complications in the postoperative period were: fungal infection,
ejection, steroid diabetes, duodenal bleeding and arterial hypertension. Two patients died. The first one died in the intensive care unit after 11 days due to severe infection. The second one died after 9 months due to severe bacterial endocarditis. Two patients survived. Cardiac index, ejection fraction and NYHA class dramatically improved after transplantation. Heart transplantation is a definitive therapy for end-stage heart failure. Infection and rejection reduce the percentage of early and late survival. That’s why it is very important to balance between immunosuppressive and antibacterial therapy. It is of great importance in the early postoperative period to monitor the patients daily clinically and laboratory. In this period we have the highest risk of infection due to the high dosage of immunosuppressant medication.