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Heart transplantation is the definitive treatment for end-stage heart failure. Post-transplant care is dynamic and complex, requiring a thoughtful multidisciplinary approach. Invasive hemodynamic monitoring is central to guiding inotrope and vasopressor titration to optimize allograft function and end-organ perfusion. Vigilant assessment for primary graft dysfunction is essential and informs escalation to mechanical circulatory support when needed. As hemodynamics and graft function stabilize, patients are liberated from mechanical ventilation, volume status is optimized, nutrition and mobility are prioritized, and pharmacologic and mechanical supports are weaned. Concurrently, immunosuppression is titrated and patients are monitored closely for infection.