Pericardial effusions after heart transplant (HT) are not uncommon.In adult HT recipients, the reported incidence of pericardial effusions ranges from 9 to 35%. [1][2][3][4] In adult studies, the data regarding risk factors for and the clinical significance of pericardial effusions after HT are conflicting. 1,2,[5][6][7][8] Though not consistent across studies, previous reports have correlated the development of early pericardial effusions after HT with lack of prior cardiac surgery, 1,2 greater recipient weight in comparison with donor weight, 1 and prolonged donor ischemic time. 4 Presence and severity of rejection have also been correlated with pericardial effusions. [5][6][7]