Background. Evaluation of coronary artery disease (CAD) is a nonstandardized practice before kidney transplantation. The aim of this study was to assess the adequacy of cardiovascular investigations in relation to cardiovascular outcomes of Middle Eastern patients undergoing renal transplantation.Methods. Seventy-five consecutive patients with end-stage renal disease in Qatar were prospectively evaluated between April 2005 and March 2008. They subsequently underwent kidney transplantation. Our prespecified protocol utilized noninvasive and/or invasive tests for the evaluation.Results. The median age was 51 years including 68% men, and 87% of patients maintained on dialysis. Overall, 21(28%) patients showed evidence of CAD, an incidence that was much higher among patients with diabetes (81%). There were 13 (17%) subjects shown to have CAD by coronary angiography in the absence of a background CAD history. The perioperative cardiovascular course was uneventful in the majority of patients except for five who developed acute coronary syndrome without mortality.Conclusion. This study confirmed the high incidence of CAD among kidney transplant candidates. Myocardial perfusion testing was not predictive of perioperative cardiac events. The incidence of perioperative cardiac complications was low; five patients (6.6%) developed acute coronary syndrome. This study suggested that kidney transplantation can be performed safely in the majority of patients regardless of age and even among those with prior evidence of CAD.