BACKGROUND Percutaneous transluminal angioplasty has now been increasingly accepted as a primary treatment option for transplant renal artery stenosis. METHODS This single-centre study evaluated the treatment effect of percutaneous transluminal angioplasty as primary intervention among 18 consecutive patients with angiographically demonstrated transplant renal artery stenosis. RESULTS Patients (14 men and 4 women, mean age 49 +/- 9 years) were followed up for a mean duration of 21.6 months after procedure. Highly significant improvement was noted in the mean arterial pressure (from baseline 105.9 +/- 10.4 mmHg to 98.6 +/- 10.0 mmHg, P < 0.001), systolic blood pressure (148.5 mmHg to 137.1 mmHg, P = 0.002) and diastolic blood pressure (85.3 mmHg to 79.4 mmHg, P = 0.002). Estimated glomerular filtration rate before and 6 months after intervention was 41.4 +/- 16.8 mL/min per 1.73 m(2) and 42.0 +/- 16.2 mL/min per 1.73 m(2), respectively (P = 0.82). CONCLUSIONS These findings show that percutaneous transluminal angioplasty in transplant renal artery stenosis appears to have a significant beneficial effect on hypertension but less impact on the improvement in renal function.