Objective: Clinical observations and some preliminary studies have suggested that an inadequate psychological adjustment to heart transplantation may increase the risk of poor clinical outcome.Yet, this issue is still lacking adequate empirical studies.We prospectively tested the predictive value of a set of psychiatric and psychological variables,collected at mid-term after heart transplantation, on the subsequent 6-year survival status.Methods: Ninety five heart transplanted patients (83% males, mean age 56 ± 10.1 years, 80% married or living as married) at 4.4 ± 3.2 years from transplantation underwent the Structured Clinical Interview for DSM-Ⅳ and the Structured Interview for Diagnostic Criteria for Psychosomatic Research (DCPR).Patients also completed Kellners Symptom Questionnaire (SQ) (anxiety, depression, somatization, hostility), Ryffs Psychological Well-Being Scales (PWB) (autonomy, environmental mastery, personal growth, purpose in life, positive relations, self-acceptance) and the World Health Organization Quality of Life-BREF (WHOQOL-BREF) (physical, psychological, social and environmental quality of life).For each patient demographic characteristics and several clinical parameters, especially immunosuppressive-related problems, were also collected.At a 6-year follow-up, survival status was recorded.Results: Analyses of survival showed that high levels of hostility (SQ) (p=0.04) and depression (SQ) (p=0.04), low scores on PWB purpose in life scale (p=0.01), the occurrence of at least one cardiac event (p=0.05), chronic renal insufficiency (p=0.04), diabetes (p<0.01), a high number of drug prescriptions (p=0.04), a NYHA Class equal or higher than Ⅱ (p=0.01) and ischemic origin of the cardiopathy (p=0.05) significantly predicted a reduced subsequent survival duration.Multivariate analyses found high levels of hostility (p=0.04) and the presence of diabetes (p<0.01) as the independent predictors of survival status.Conclusions: These findings point out the predictive role of specific components of psychological adjustment to heart transplantation, especially hostility.They also pose the basis for the evaluation of whether the amelioration of empirically identified psychological risk factors, through pharmacological or psychotherapeutic interventions, may result in a better long-term outcome.