OBJECTIVE The purpose of this study was to assess the safety and efficacy of percutaneous coronary intervention (PCI) with bare-metal and drug-eluting stent (DES) use in pediatric orthotopic heart transplantation (OHT) recipients who developed transplant coronary artery disease (TCAD). BACKGROUND The short- and long-term outcomes in pediatric OHT patients with TCAD who underwent PCI are not well known. METHODS A retrospective review of medical records from two centers of pediatric OHT recipients who underwent PCI for TCAD was performed. From 1994 to 2011, twelve patients underwent PCI for TCAD at the two centers. RESULTS The mean age at PCI was 15.1 ± 3.5 years, and the time since transplant was 7.0 ± 4.8 years. Procedural success was attained in all patients. Seven patients (58.3%) received DESs. All patients were free from major adverse cardiac events (MACE) at 3 months. At a mean follow-up of 7.1 ± 4.9 years, 6 patients (50%) experienced MACE: 4 patients (33%) died (2 with rejection, 1 with possible stent thrombosis, and 1 had sudden death), 1 patient (8.3%) had myocardial infarction, and 1 patient (8.3%) underwent target vessel revascularization. Five patients (41.2%) underwent repeat OHT. Surveillance angiography was performed in 6 patients (50%), and binary restenosis was observed in 2 patients (33.3%), both of whom received DESs. CONCLUSIONS Even though TCAD is a progressive disease, PCI is a feasible and effective palliative measure in pediatric OHT recipients. Noncompliance to immunosuppressive and antiplatelet therapy can contribute to MACE in these patients.