Off-pump coronary artery bypass grafting is rarely applied to patients who have previously received a renal transplant in Japan. A 59-year-old male renal transplant recipient was admitted for unstable angina pectoris. Emergency coronary angiography revealed triple-vessel disease. Intraaortic balloon pumping was applied, followed by emergency off-pump coronary bypass grafting for complete revascularization. Intraaortic balloon pumping was ceased immediately after the operation because his hemodynamic status was stable. On the morning of the surgery, the patient was given his standard dose of immunosuppressive agents. On postoperative day 1, he was extubated and infused with immunosuppressive agents. On postoperative day 2, his usual immunosuppressive agents were resumed as per his normal dosage. He recovered uneventfully and is well without angina pectoris and renal complication 1 year after the operation.