Abstract Objective To determine whether long-term survival (>10 years) after heart transplantation is possible and identify complications influencing long-term survival. Methods We analyzed clinical outcomes in the group of 21 patients who had undergone heart transplantation at the Second Affiliated Hospital of Harbin Medical University since 1992 and 4 of them survived more than 10 years. Results Nine patients are still alive with normal left ventricular function, and 4 of them have survived more than 10 years. The longest survival patient has lived more than 18 years after transplantation, whose survival is the longest in China and in Asia. We have also found that there has been a high incidence of complications, such as rejection episodes during the first 6 months, and transplant vasculopathy in the long-term survival patients. Conclusion Long-term survivors maintain normal hemodynamic function of their allografts, and long-term survival following cardiac transplantation is possible. Aggressive preventive and therapeutic measures are essential to limit the risk factors for development of complications such as rejection episodes and transplant vasculopathy, and enable long-term survival after cardiac transplantation.