Abstract Body (Do not enter title and authors here): Background: Intestinal ischemia is an uncommon but life-threatening complication in heart transplant recipients. We evaluated the association between surgical intervention and in-hospital mortality among cardiac-transplant recipients who developed intestinal ischemia.

Methods: We conducted a retrospective cohort study using the 2017–2022 National Inpatient Sample (NIS). The study included non-elective, adult (≥18 years) admissions with a diagnosis of intestinal ischemia or infarction and a history of heart transplantation using the ICD-10 codes. Surgical interventions were identified using ICD-10-PCS codes for laparotomy, laparoscopy, colectomy, small bowel resection, and ostomy formation. Time to surgery was calculated from admission and categorized as early (≤1 day) or late (>1 day). Survey-weighted logistic regression estimated adjusted odds ratios (aORs) for in-hospital mortality, adjusting for demographics, hospital characteristics, and Charlson Comorbidity Index.

Results: Among a total of 205,326,535 weighted hospitalizations in the NIS from 2017 to 2022, 97,214 patients met inclusion criteria as adults (≥18 years) with a history of heart transplantation. Of these, 765 patients were diagnosed with intestinal ischemia. Among them, 280 patients (36.6%) underwent surgical intervention, including laparotomy, laparoscopy, colectomy, small bowel resection, or ileostomy/colostomy. The mean age was 60.3 years, and 29.5% were female. Colectomy was significantly associated with higher in-hospital mortality (aOR 3.66; 95% CI, 1.07–12.44). Small bowel resection showed increased odds (aOR 3.00; 95% CI, 0.94–9.61). Early laparotomy was associated with elevated mortality risk (aOR 9.83; 95% CI, 0.63–153.76), while late laparotomy showed a trend toward lower odds (aOR 0.10; 95% CI, 0.007–1.59). Laparoscopy was associated with a lower but non-significant aOR (aOR 0.28; 95% CI, 0.003–27.01). Any surgical intervention was associated with significantly higher adjusted odds of in-hospital mortality (aOR 3.36; 95% CI, 1.23–9.17).

Conclusions: In cardiac-transplant recipients with intestinal ischemia, abdominal surgery particularly colectomy and early laparotomy was associated with higher adjusted odds of in-hospital death, whereas late laparotomy and minimally invasive procedures showed no excess mortality risk. These findings suggest that operative timing and choice of less invasive management options for post-transplant bowel ischemia may influence outcomes.