Heart transplantation remains the treatment of choice for patients with end-stage heart failure allowing high-survival rates and improved quality of life1. Worldwide, more than 6000 heart transplantations are performed annually, with one-year post-transplant survival around 85% and median survival now exceeding 12 years2. The progressive improvement in post-transplant outcome that has been observed over these years is mostly driven by a dramatic drop in the early post-transplant mortality2. However, the first weeks following heart transplantation remain critical with an 8% 1-month mortality in contemporary cohorts2. The perioperative period remains at very high risk due to the increasing proportion of candidates bridged to transplant with durable mechanical circulatory supports and an increasing number of sensitized patients3,4. In addition, the prioritization of high-risk candidates on ECMO support and the broader eligibility for both recipient- and donor-related risk factors of primary graft dysfunction (older age, comorbidities) also contribute to increase the challenges of the perioperative period2,5. The role of the cardiothoracic anesthesiologist-intensivist in the early management of heart transplant recipients is crucial both during surgery and in the ICU6. Guidelines focused on the perioperative management of heart transplant recipients are still lacking and the area of knowledge required is vast. This includes the management of hemodynamic instability, transfusion and hemostatic disorders, immunosuppression, infectious complications (prevention and treatment) in addition to acute kidney injury and renal replacement therapy. This review aims at summarizing the latest knowledge in the field of perioperative management of heart transplant recipients in order to guide cardiothoracic anesthesiologist-intensivists.