Primary graft dysfunction (PGD) is observed in approximately 7% of all heart transplant (HTx) patients (pts). According to the International Society for Heart and Lung Transplantation (ISHLT), a new PGD scale includes left ventricular (PGD-LV), or right ventricular (PGD-RV). PGD-LV when severe is noted to have increased mortality. PGD-RV has been described as hemodynamics with RAP >15 mmHg, PCWP <15 mmHg, CI < 2.0 L/min/m2, or need for RV temporary support. PGD-RV has not been well studied. Between Dec 2013 and Dec 2018, we assessed 13 HTx pts who developed PGD-RV within 24 hours after HTx and compared them to pts without PGD. Endpoints included 1-year survival, need for temporary kidney dialysis, need for RV unloading with sildenafil, first year rejection including any treated rejection (ATR), 1-year freedom from cardiac allograft vasculopathy (CAV), and 1-year freedom from non-fatal major adverse cardiac events (NF-MACE, defined as myocardial infarction, percutaneous coronary intervention/angioplasty, new congestive heart failure, pacemaker/implantable cardioverter-defibrillator placement, and stroke). Pts with PGD-RV compared to pts without PGD had similar 1-year survival, freedom from CAV, freedom from NF-MACE, and rejection. 90% of pts with PGD-RV required RV unloading therapy which may have affected outcome. There was a trend for a lower freedom from temporary kidney dialysis in the PGD-RV group. PGD-RV after HTx appears to have acceptable outcome with good recovery. RV unloading therapy may be helpful. However, there was an associated increased need for temporary kidney dialysis within the first year after HTx. Larger numbers are warranted to confirm these findings.