Steroid-free immunosuppression has been reported to be successful in select cardiac transplant recipients. Further reduction of immuno-suppression meditation (using cyclosporine alone) has been reported; however, there is concern regarding long term outcome. In our institution, since 1989, 16 cardiac transplant patients on double-immunosuppression (cyclosporine and azathioprine) whose WBC decreased to less than 4,000 were also taken off azathioprine and maintained on mono-immunosuppression (cyclosporine alone). Five year actuarial survival for this group is 92%, and there has been no evidence for transplant coronary artery disease (defined as any luminal irregularity) in any of the annual coronary angiograms. Comparison of actuarial survival curves between mono-immunosuppression patients and tripleimmunosuppression patients is as follows:Mono-immunosuppression (cyclosporine alone) appears successful in select cardiac transplant recipients. The low risk for transplant coronary artery disease may be due to a lowering of associated risk factors and the selection of an “immuno-privileged” patient population.