Accelerated coronary disease following cardiac transplantation is an important obstacle to long-term survival and its management is not well defined. Coronary angioplasty has been proposed as a palliative treatment in some patients with discrete proximal lesions. Of 172 patients who underwent cardiac transplantation between April 1983 and November 1995, 8 underwent subsequent coronary angioplasty of 11 lesions. The majority was performed in asymptomatic patients, 5 for angiographic abnormalities alone, and 3 for documented painless ischemia. Primary angiographic success was obtained in 91% (10/11) of lesions dilated. Complications included 1 acute occlusion and 1 arteriovenous fistula. Three patients died, 1, 8 and 10 months after angioplasty. After an average of 36-month follow-up, 4 (out of 8) patients had no cardiac event (myocardial infarction, second angioplasty, retransplantation or death). Thus, coronary angioplasty can be performed with acceptable risk in selected patients with cardiac transplantation.