Objective To analyze the risk factors of early tricuspid regurgitation after heart transplantation, and to summarize the experience of donor and recipient evaluation and perioperative management of heart transplantation, so as to increase the survival rate and decrease the incidence of early right ventricular dysfunction in patients after heart transplantation. Methods A total of 74 patients who underwent orthotopic heart transplantation in our hospital from Mar. 2017 to Nov. 2019 were selected and divided into 2 groups according to the ratio of tricuspid regurgitation bundle area to right atrial area (group 1[15 cases, with the ratio<20%] and group 2[59 cases, with the ratio ≥ 20%]). The hearts were obtained according to the donor heart standards. The pulmonary artery systolic pressure (PAPs) and other indicators were monitored preoperatively by Swan-Ganz catheter, and the degree of tricuspid regurgitation within 30 days after surgery was evaluated by echocardiography. Multiple logistic regression model was used to analyze the influencing factors of early tricuspid regurgitation after heart transplantation. Results There were significant differences in primary graft failure (PGF), acute rejection, donor-to-recipient body weight ratio and preoperative PAPs between the two groups (all P<0.01). There were no significant differences in donor age, recipient age, donor and recipient gender match, preoperative New York Heart Association (NYHA) heart function classification, primary diseases, donor-to-recipient height ratio, preoperative total bilirubin level or preoperative right ventricular anteroposterior diameter between the two groups (all P>0.05). Multiple logistic regression analysis showed that PGF (odds ratio[OR]=1.892, 95% confidence interval[CI]1.150-1.972), acute rejection (OR=1.625, 95% CI 1.190-1.885), donor-to-recipient body weight ratio (OR=0.001, 95% CI 0.000-0.873) and preoperative PAPs (OR=1.274, 95% CI 1.099-1.498) were the influencing factors for early tricuspid regurgitation after heart transplantation (all P<0.05). Conclusion Matching the body weight of donor and recipient, preventing perioperative pulmonary hypertension, applying immunosuppressant strictly and preventing PGF are beneficial to reduce early tricuspid regurgitation and right heart failure after heart transplantation.