Renal transplantation is the treatment of choice in patients with end-stage 
renal disease. Major adverse cardiac events (MACE) are common after renal 
transplant, especially in the perioperative period, leading to excess morbidity 
and mortality. The predictors and long-term prognostic implications of MACE are 
poorly understood. We analyzed predictors and implications of MACE in a cohort 
of 321 consecutive adult patients, who received renal allograft transplantation 
between 1995 and 2003 at our institution. The characteristics of 321 patients 
were: age at transplant 44 ± 13 years, 60% male, 36% diabetes mellitus (DM), 
left ventricular ejection fraction (LVEF) 60 ± 16%. MACE occurred in 21 patients 
with cumulative rate of 6.5% over 3 years after renal transplant, 57% occurring 
within 30 days, 67% within 90 days, and 86% within 180 days. MACE was not 
predicted by any clinical or pharmacological variables including age, gender, 
hypertension, DM, prior myocardial infarction, smoking, duration of dialysis, 
LVEF, or therapy with β-blockers (BB), angiotensin converting enzyme inhibitors, 
or calcium channel blockers. However, a clinical decision to perform a stress 
test or a coronary angiogram was predictive of higher MACE rate. MACE, 
irrespective of type, was independently associated with higher mortality over a 
period up to 15 years and this seemed to be blunted by BB therapy. MACE rate 
after renal transplantation decreases over time, most occurring in the first 90 
days and is not predicted by any of the traditional risk factors or drug 
therapies. It is associated with higher long-term mortality.