Cardiac surgery causes high mortality among post-renal-transplant patients. These patients are on steroids, which can accelerate atherosclerosis, and on immunosuppressive drugs, which expose the patient to infection. Here we report a case of a post-renal-transplant patient who underwent off-pump coronary artery bypass graft surgery with favorable outcome. In the present case, perioperative renal dysfunction was prevented by maintaining strict asepsis and adequate renal perfusion, by titrating the fluid based on pulmonary artery pressures, by maintaining urine output greater than 1 ml/kg/h, by avoiding cardiopulmonary bypass, and by titrating drugs according to the bispectral index, which resulted in early extubation and better outcome of the patient.