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Introduction: While outcomes and risk factors for pediatric and adult heart transplantation have been well studied, little is known regarding the risk factors of adolescent or young adult patients undergoing heart transplantation. The child-to-adult transition is associated with poorly understood challenges and risk factors that may contribute to increased risk after transplant. Methods: The United Network of Organ Sharing (UNOS) database was used to identify heart transplants performed between 1987 and 2015. The 50267 patients identified were stratified by age: pediatric (<13 years, N=4729), transitional (13-24 years, N=3102), and adult (>24 years, N=42436). Patients receiving re-transplantation were excluded from analysis. Outcomes are reported by age and analyzed using the chi-squared test or ANOVA. Survival analysis with a multivariate Cox proportional hazards regression model using demographic, diagnostic, comorbidity, and biomarker variables was performed and analyzed during the early (<12 months) and constant (>12 months) phase after transplant. Results: Within the follow-up period, transitional patients suffered greater rates of cardiovascular death, re-transplantation, graft failure, and acute rejection than pediatric or adult patients. During the early phase older age was associated with greater risk of death or re-transplantation. However, transitional age was a risk factor during the constant phase relative to pediatric (HR=0.57) or adult (HR=0.67) age. Other early phase risk factors included advanced mechanical support and renal replacement therapy. Race and insurance status were important risk factors during the constant phase. Conclusions: The transitional age is associated with an increased risk of mortality or re-transplantation during the constant phase (>12 months) post-transplant. Further research is needed to assess and address the challenges that face transitional age patients after transplantation. [ABSTRACT FROM AUTHOR]