Vasoplegia occurs in up to 16% of patients who undergo heart transplantation 
(HT) and is associated with significant morbidity and mortality. We present a 
case of a 61-year-old man with ischemic cardiomyopathy receiving 
sacubitril/valsartan (Entresto; Novartis, Cambridge, MA) who developed profound 
hypotension after HT. He was treated with intravenous methylene blue and 
high-dose vasopressors, but developed acute kidney injury requiring dialysis and 
a prolonged stay in the intensive care unit. This case supports a potent 
vasodilatory effect of sacubitril/valsartan, and if confirmed by other studies, 
might warrant consideration for withholding treatment while awaiting HT, 
particularly in patients with risk factors for vasoplegia.