The first heart transplantation (SHT) was performed by Professor Ch. Barnard in 1967 but it was not until 1980s that this method became an established approach to treatment of patients with end-stage heart failure. Considering the limited number of donor organs and the number of potential post-transplantation complications, the decision to perform heart transplantation at the right time in an indicated patient is difficult and complex. Subsequent pharmacological management with immunosuppressive agents and other medication becomes everyday life reality. Knowledge of drug interactions and collaboration with cardiologists are necessary in order to maintain long-term treatment success. Despite the current developments in surgical methods, examination methods and immunosuppressant therapy, a range of complications has to be dealt with. The future of care for patients with transplants will rely on the development of new immunosuppressive drugs with a minimum of adverse effects and discovery of a non-invasive technique for graft rejection diagnosis.