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Abstract: Aim: To assess the prognostic value of a PH reversibility test with NPS to predict early death risk after orthotopic heart transplantation (OHT). Materials and Methods: We analyzed the results of 94 consecutive OHT procedures performed from 2002 to 2003. Pulmonary vascular resistance (PVR) and transpulmonary gradient (TPG) were assessed as part of the routine pre-OHT evaluation. PH was excluded in 57 patients (61%, group A); TPG = 12 mm Hg and/or PVR > 2.5 Wood units were observed in 37 patients (39%). Sixteen patients underwent a PH reversibility test with NPS: 9 patients (group B) achieved normal TPG and PVR without a drop in systolic arterial pressure (BPs > 85 mm Hg), while a marked decrease of BPs (< 85 mm Hg) during NPS infusion was observed in 7 patients (group C). Then, 21 patients were selected for OHT despite PH without any reversibility test. We compared the number of early deaths after OHT among groups (chi-square test). Results: The 30-day death rate was 7% in group A, 11% in group B, 71% in group C, and 29% in group D. (A vs C, P = .0001 and A vs D, P = .03). Right ventricle or biventricular failure was the cause of death in 1 patient in group A, 1 patient in group B, 5 patients in group C, and 6 patients in group D (A vs C, P < .0001 and A vs D, P = .0012). Conclusion: PH reversibility revealed with NPS does not increase the risk of early death after OHT unless there is an absence of marked fall in systemic pressure. [Copyright &y& Elsevier]