Several studies reported the impact of cardiac surgical operation on morbidity and mortality in renal transplant recipients as well as on renal graft function and safety and effect of immunosuppressant medication.1-3 However,few data are available about the risk and immunosuppressant medication in patients who undergo cardiac surgical operation after successful renal transplantation,especially in patients who underwent offpump coronary artery bypass grafting (CABG) with previous renal transplantation.This research provides important insights into the immunosuppressive management of a patient requiring valve replacement or CABG after renal transplantation during the perioperative period.