Chronic graft rejection is manifested in cardiac allografts as chronic vascular rejection of main and intramuscular coronary arteries. Myointimal proliferation and medial scarring result in diffuse and eccentric arterial narrowing referred to as accelerated graft atherosclerosis. Infection remains the primary cause of death within the first year of cardiac transplant, but accelerated graft arteriosclerosis is the most common cause of mortality thereafter. Percutaneous transluminal coronary angioplasty, coronary artery bypass grafting, and re-transplantation are the current options for combating this problem.