The field of transplantation along with all of medicine has made tremendous progress in the past 30 years. Patients with end-stage renal disease are managed more effectively despite increasing chronic multisystemic comorbidities, particularly involving their cardiovascular system. These same patients are also undergoing renal transplant surgery with better short- and long-term results than any era previous. We will present some of the changing demographics encountered in today's renal transplant candidates along with the processes our institution is undertaking to optimize the patient's success with the renal allograft, particularly with respect to the diagnosis and therapeutics used to manage coronary artery disease. Copyright © 2001 by W.B. Saunders Company.