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An acute abdomen (AA) may occur following heart transplantation (HTx). Patients (pts) with atherosclerotic vascular disease may also have risk for ischemic bowel associated with their surgeries. In addition, pts with gallstones are at increased risk for cholecystitis immediately following cardiac surgery. The frequency and outcomes of these abdominal complications that warrant urgent abdominal surgery after HTx has not been well established. Furthermore, the presence of increased inflammation in abdominal surgery may trigger an immune response and thereby cause rejection. We sought to evaluate these complications in our large, single center experience. Between 2010 and 2021, we assessed 1154 pts who underwent HTx and reviewed frequency of AA requiring surgical intervention (n=11) in the first month following HTx surgery. These pts were assessed for 30-day and 1-year survival, allograft rejection, and infectious complications requiring intravenous antibiotics and/or readmission in the ensuing 3 months. The AA pts were compared to a case-controlled group (n=22) matched for age, sex, and time of transplant. 11 of 1154 pts (1.0%) of our HTx pt population developed an AA and required surgical intervention within the 30 days following HTx. Surgical interventions included hemicolectomy, cholecystectomy, and exploratory laparoscopy. Compared to the control group, the AA group had significantly worse 30-day and 1-year survival. In the study group, further infectious complications occurred, with 36.4% requiring rehospitalization for intravenous antibiotics. Rejection episodes following these events were not different from the control population. Acute abdomen immediately post-HTx resulting in urgent abdominal surgery requiring hemicolectomy and/or cholecystectomy is rare but has significant morbidity/mortality. For pts awaiting HTx with gallstones, prophylactic laparoscopic cholecystectomy might be considered. [ABSTRACT FROM AUTHOR]