UNSTRUCTURED Introduction: Cardiovascular disease is a major cause of morbidity and is now the leading cause of death in patients with renal transplants. We report a case of acute myocardial infarction three weeks post renal transplant. Case Report: A 45 year old male renal transplant renal transplant recipient presented three weeks post-transplant with acute chest pain, hypotension and atrial fibrillation. He was found to have Infero-posterior wall myocardial infarction. He was thrombolysed with Tenectaplase, and developed a perinephric hematoma six hours later. He underwent transfusions and pigtail drainage of the hematoma. The hematoma resolved, and he was started on dual anti-platelets with stable renal function. Conclusion: Thrombolysis in the early post-transplant period is considered a very high risk procedure. Our case illustrates the use of the thrombolytic therapy in the early post transplant period and successful management of the attendant complications.