Serious complications involving the alimentary tract are commonly reported following cardiac transplantation, and may be associated with significant morbidity and mortality. The aim of this report was to review the incidence, severity, and outcome of abdominal complications in our heart transplant population in whom we used corticosteroid-sparing protocols for immunosuppression. From March 1985 through September 1988, 178 patients underwent 185 cardiac transplants. Twenty-six cardiac transplant recipients (15%) sustained 33 major abdominal complications, including gastrointestinal bleeding (n = 8), pancreatitis (n = 8), bowel perforation (n = 6), cholecystitis (n = 4), and miscellaneous other problems (n = 7). Operative therapy was required in 61% of cases. No deaths were caused by the gastrointestinal complications of their operative management. Corticosteroid-sparing immunosuppression may be responsible for the low incidence of abdominal morbidity, and early, aggressive surgical intervention may reduce subsequent mortality.