Cardiac transplantation has had a major impact on the quality of life and longevity of an ever-increasing number of patients. This benefit is significantly eroded by the development of an accelerated form of coronary arterial disease which shows some, but not all, of the characteristics of native coronary artery disease, and itself is one of the major indications for transplantation.If cardiac transplantation is to realize its potential, it is essential to prevent transplant-related coronary disease. This can only be done by thorough understanding of the basic mechanisms involved. This could help in the fight against native atherosclerosis, which has a major impact on the community and in preventing vascular damage after other solid organ transplantation. To date, there is no agreement or good guidelines about the management of chronic rejection. Transplant-associated coronary disease is a multifactorial disease contributed by genetic factors in the donor and recipients. It is also linked to events occurring during brain death, harvesting and implantation, and most importantly, events after transplantation. The latter events can be conveniently divided into antigen-dependent and antigen-independent with immunological causes playing a part in both.Recent work has resulted in major and significant accumulation of knowledge in this field, particularly in the molecular mechanisms and to some extent, management, of the disease. This knowledge is extensively and methodically reviewed in this volume by a group of experts in the field.