Heart transplantation remains the definitive treatment for many patients with end stage heart failure. Advances in mechanical circulatory support, expanded donor criteria, and novel organ preservation have expanded the scope of both donor and recipient eligibility while maintaining excellent outcomes. However, even with these advances, meticulous postoperative care remains an essential component of successful heart transplantation. While post heart transplant critical care shares similar considerations to conventional cardiac surgery, there are many heart transplant specific factors that must be taken into account. This chapter will provide a review of care after heart transplant with consideration of the patient population and the unique pathophysiology of the post-transplant state.