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Background.Rheumatic heart disease (RHD) remains significant cause of cardiovascular disease worldwide.The non-suppurative cardiovascular sequel of group A streptococcal infection causes sustained inflammatory and immune reactions toward the myocardium and valves.This study attempted to determine whether the inflammatory response continues attacking a new heart and the long-term outcome after transplantation.Methods and Results.Sixteen patients with end-stage RHD at National Taiwan University Hospital between June 1995 and March 2005 were enrolled in this study.Twenty dilated cardiomyopathy (DCM) patients were enrolled as the control group.The RHD group experienced more right ventricular failure and higher central venous pressure than the control group, which resulted in impaired liver and kidney function.The RHD patients had a higher incidence of tricuspid regurgitation than the control group (31.6% vs.1.5%, p=0.018).No differences existed between the two groups for 5-year and 10-year survival rate (RHD 54.17% vs.DCM 75.67%, p=0.41).Conclusions.The RHD patients suffered more tricuspid regurgitation than the control group.The aortic and mitral valves in both groups functioned well over the long run.Inflammatory and immune reactions did not attack the new heart valves and myocardium.Heart transplant for end-stage RHD achieved long-term survival rates similar to that for the control group.