Despite recent improvements in mechanical circulatory-assist devices, it is hard to compete with the excellent median overall survival of 10.7 years for all patients who received transplants from 1982 to 2015 [8]. In particular, the mortality rate remains consistently low if the patient survives the critical first 12 months after the transplant: Long-term deaths are due mainly to infectious diseases in immunocompromised patients (e.g. multiorgan sepsis), immunosuppression-associated malignancies (such as post-transplant lymphoproliferative disease as a result of immunosuppression) and progressive cardiac allograft vasculopathy (Fig. 3) [8]. Future research should focus on these factors.