Orthotopic heart transplantation (OHT) continues to be the gold standard for the management of patients with end-stage heart failure. However, there are regional variations in perioperative care and outcomes. Long-term survival data published by the International Society of Heart and Lung Transplantation may not be reflective of center specific outcomes. We undertook this analysis to review our single center outcomes in patients receiving OHT. This is a retrospective cohort analysis of all patients who underwent OHT between December 1, 1988 and October 21, 2014 through the BC Heart Transplant Program. Overall long-term survival at 25 years was determined. Survival at 10-years was stratified by induction strategy, sex and treatment era (early: 1998-2001, late: 2002-2014), and compared using the log-rank test. Over the study period, a total of 406 patients were transplanted, 6 of whom were re-transplanted and excluded from our analysis. Of the remaining 400 patients, 307 (76.8%) were males and the average age was 52.1 years. The median follow-up time was 6.6 years. Overall long-term survival was 34.5% at 25 years with a median survival of 15.5 years (Figure 1). Conditional survival beyond 1-year was 41.3% at 25 years with a median survival of 18.5 years. Survival at 10-years in the early era (59.8%) was significantly lower versus late era (76.9%; p=0.04). Survival at 10-years amongst male (68.4%) versus female (72.0%) recipients was similar (p=0.67). Basiliximab, rabbit anti-thymocyte globulin (RATG), and OKT3 were used in 184, 99, and 87 patients, respectively. There was a significant difference in 10-year survival amongst the basiliximab (78.8%) RATG (68.7%) and OKT3 (55.2%) treatment groups (p=0.02), but no difference between the basiliximab and RATG groups (p=0.70). Our long-term survival for OHT patients is acceptable at 34.5 % at 25 years. There are no differences in outcomes based on the commonly used induction agents or sex. The difference in survival based on treatment era may be driven by choice of induction and immunosuppression strategies as well as improvements in pre- and post-transplant care.