Introduction: Intravascular Ultrasound (IVUS) detection of cardiac allograft vasculopathy (CAV) defined by maximal intimal thickness (MIT) has been associated with reduced survival rates post orthotopic heart transplant (OHT). Currently, there is little data on the prognostic importance of baseline intimal hyperplasia due to donor transmitted atherosclerosis (DTA) and its influence on outcomes.Methods: Retrospective analysis was performed of 196 patients who underwent OHT from 1/2009-12/2014 and had baseline and 1yr IVUS performed as part of routine clinical care. DTA was defined as baseline MIT >0.5 mm. CAV was defined as 1yr MIT ≥0.5 mm or DTA with an increase in MIT ≥0.5 mm. The primary outcome was the difference in all-cause mortality between patients with CAV vs. non-CAV. The secondary outcome was the difference in all-cause mortality between patients with DTA vs. non-DTA. Kaplan-Meier analysis was used to compare the survival curves between 4 subgroups of patients with and without DTA and CAV.Results: At baseline DTA was detected in 52% of patients. Those with DTA were more likely to have older donor age (p<0.0001) and a male donor (p=0.001). At 1 year, 21% of patients had developed CAV. Those developing CAV had younger donor age (p=0.01) and lower baseline MIT (p<0.001). Over median follow-up of 4.6 years, the all-cause mortality was similar between the 2 groups (P = 0.26) (Fig 1A). There was an unexpected trend toward better survival in the DTA group (p=0.07) (Figure 1B), but KM analysis did not reveal any interaction between CAV and DTA (P = 0.31) (Figure 1C).Conclusions: In this single center contemporary cohort DTA and CAV were not associated with adverse mid-term prognosis. This is relevant given the potential increase of vascular risk factors in the donor pool that could accompany efforts to expand the pool with donors who may have been previously excluded. Further study to assess the impact of DTA and CAV on outcomes and predictors of prognosis post OHT is warranted.