In parallel to increasing numbers of orthotopic heart transplantations performed during recent years, the proportion of patients with preexisting ischemic cardiomyopathy (ICM) enlarged. The present study examined peri- and postoperative risk factors and the prognosis of patients with coronary artery disease after orthotopic heart transplantation in comparison to a group with dilatated cardiomyopathy (DCM). This comparison revealed a higher risk of severe rejection episodes in patients with coronary artery disease, whereas infections were not more frequent. Graft atherosclerosis was found in a higher incidence in patients with preexisting ICM than in the DCM group. The overall incidence of graft atherosclerosis was less than 10% at one and at two years after orthotopic heart transplantation. Postoperative renal function was more impaired in the group of ICM patients, although blood levels of cyclosporine A were lower in this group. In the ICM group one and two year survival rates were 75% and 74%, respectively. Although survival rates are lower in this patient group, if compared to DCM patients (84% and 83%), orthotopic heart transplantation seems to be acceptable therapeutic alternative for endstage coronary artery disease.