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Prevalence of iron deficiency and anemia in the setting of modern-day maintenance immunosuppression in pediatric heart transplant (HTx) recipients is unclear. We aim to determine the prevalence of iron deficiency (ferritin < 30 ng/mL) and anemia (hemoglobin < 11 g/dL) in this population using World Health Organization diagnostic criteria for children. Single-center, observational, analysis of 200 consecutive pediatric HTx recipients (< 21 yo) from 2005-2021. Data was collected at 1-year post-HTx at time of annual protocol biopsy. Primary aim was proportion of these patients with iron deficiency and anemia and associated risk factors for iron deficiency and/or anemia. Median age at transplant was 3 years (IQR 0.5 - 12.2). Median time from transplant to iron studies and CBC was 373 days (IQR 362 - 411). Median ferritin level was 32 ng/mL (IQR 20.5-73.5) with 46% having ferritin < 30 ng/mL. Median hemoglobin (Hb) was 11 g/dL (IQR 10.3 - 12.3) with 45% having Hb < 11 g/dL. Ferritin was significantly higher in patients with CMV viremia (viremia 55 vs no viremia 28 ng/mL, p=0.04). Hb was significantly lower in cyclosporine vs tacrolimus-based regimens (10.7 vs 11.4 g/dL, p=0.002) and in children ≤ 5 vs > 5 yo at transplant (10.9 vs 11.6 g/dL, p=0.001). Hb did not differ significantly in those with ferritin < 30 vs ≥ 30 ng/mL (11.8 vs 11 g/dL, p=0.13) nor did ferritin differ significantly in those with Hb < 11 vs ≥ 11 g/dL (40 vs 30 ng/mL, p=0.09). Of those with ferritin < 30 ng/mL, less than a third also had Hb < 11 g/dL. Enteral iron supplementation (n=59) was associated with greater proportion of patients with ferritin ≥ 30 ng/mL (51.6% vs < 30 ng/mL 20.8%, p=0.001) though Hb < 11 g/dL (38.2% vs ≥ 11 g/dL 22.9%, p=0.03). Iron deficiency and anemia in isolation are prevalent in pediatric heart transplant recipients at 1-year post-transplant, although iron deficiency and anemia were not directly correlated in this study. Younger age and cyclosporine use appear to be associated with anemia in this population. [ABSTRACT FROM AUTHOR]