Perforin is a cytolytic mediator produced by cytotoxic T cells (CD8+cells) and natural killer cells. We previously reported that ex vivo IL-10 gene therapy induced apoptosis of allogenic infiltrative CD8+cells and significantly prolonged cardiac allograft survival. To further test the hypothesis that localized IL-10 overexpression in cardiac allografts may also effect the alloreactive CD8+T cell function by downregulating its perforin production, we used a rabbit functional heterotopic allograft heart transplant model. Human recombinant IL-10 gene complexed with liposome was intracoronary delivered into the cardiac allografts ex vivo. The percentage of apoptotic infiltrative CD8+cells in cardiac allografts was increased 6-fold in the gene therapy group vs. the control group, whereas the percentage of perforin-positive CD8+cells was decreased 2.9-fold ( P < 0.01). Perforin expression level in the allograft myocardium of the gene therapy group was deceased 3.2-fold ( P < 0.01). The amount of infiltrative perforin-positive CD8+cells and perforin expression level were inversely correlated with IL-10 transgene and protein expression level in the myocardium of cardiac allografts ( P < 0.01), the percentage of apoptotic cardiac myocytes ( P < 0.01), and the peak left ventricular systolic pressure of cardiac allografts ( P < 0.01) but significantly correlated with the infiltrative T cell cytotoxicity ( P < 0.01) and allograft rejection score ( P < 0.01). These results suggest that localized IL-10 gene therapy prolongs cardiac allograft survival, at least in part, through downregulation of perforin production by activated allogenic CD8+T cells. Reduction of cytolytic function of cytotoxic effector cells prevents the apoptosis of cardiac myocytes.