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Seizures may occur following heart transplantation (HTx), especially since tacrolimus can lower a seizure threshold. HTx recipients are also at high stroke risk given many patients have existing cerebrovascular disease. The purpose of the study was to assess the prevalence and risk factors for seizures in HTx recipients at our center. We assessed 560 patients who underwent HTx between 2015-2020 for the development of seizures within the first month post HTx. We assessed impact of putative risk factors on early post transplant seizures, including prior stroke, atherosclerotic vascular disease, prior seizures, diabetes, prior smoking, and male sex. 40 of 560 HTx patients (7.3%) developed seizures in the first post-transplant month. The seizure group was compared to the control group (n=520) for risk factors for seizures (see table). Univariate analysis found that hypertension, history of atherosclerosis, and history of previous seizures were significant risk factors to develop seizures in the first postoperative month. Multivariate analysis found that only hypertension and history of previous seizures were significantly associated with early seizures post-HTx. All patients with seizures were placed on anti-seizure medications and had tacrolimus switched to cyclosporine. Seizures in the first post-transplant month occur in a significant minority of patients. Patients undergoing heart transplant with both history of hypertension and seizures are at risk to develop seizures in the early postoperative period. These patients might be considered for prophylactic anti-seizure therapy in the first 30 days following HTx surgery. [ABSTRACT FROM AUTHOR]