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BACKGROUND Cardiovascular disease remains the leading cause of morbidity and mortality in kidney transplant (KT) recipients. Stress echocardiography (STE) is frequently used in pretransplant risk stratification, but its prognostic value in predicting posttransplant outcomes is uncertain. This retrospective study from a single center aimed to evaluate pretransplant STE findings in 354 KT recipients and their association with posttransplant major adverse cardiovascular events (MACE). MATERIAL AND METHODS We included KT recipients from our Midwest academic institution between January 2015 and January 2024 who underwent pretransplant STE. STEs were classified as positive (ischemic EKG changes or new wall motion abnormalities) or negative. MACE was defined as cardiovascular death, acute coronary syndrome, heart failure hospitalization, fatal arrhythmia, or stroke. Kaplan-Meier survival curves and Cox regression models were constructed to assess the associations between STE parameters and outcomes. RESULTS Among 354 KT recipients, 58 (16.3%) had a positive STE. Over a mean follow-up of 54±19 months, 67 patients (18.9%) experienced MACE. In unadjusted analyses, age, diabetes, and coronary artery disease were associated with higher MACE risk; however, positive STE was not significantly associated with outcomes. In multivariable models, abnormal STE remained unassociated with MACE or the composite outcome. Kaplan-Meier survival analysis confirmed no difference in MACE-free survival between groups. CONCLUSIONS In this contemporary single-center cohort of KT recipients, abnormal pretransplant STE was not independently associated with posttransplant cardiovascular events. These findings suggest the need to re-evaluate the role of traditional stress testing targeted toward detecting myocardial ischemia in pre-KT evaluation.