Having discussed patient selection for transplantation in their previous recording, Drs Sudhir Kushwaha and Rocky Daly—respectively the medical and surgical directors of the heart transplantation and ventricular assist device (VAD) therapy program at Mayo Clinic, turn their attention to management of the patient in the perioperative and postoperative setting. In a rapidly changing field, they share their expertise with the latest options in immunosuppressive strategy and thoughts on the long-term management of those who have had a transplant.