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Background: Waitlisted kidney transplant patients suffer from excess cardiovascular events. The benefits of regular cardiac investigations, potentially harmful and expensive, are unknown. We investigate the effectiveness of a cardio-renal MDT in managing high cardiovascular risk waitlisted transplant patients to prevent events and enable transplantation., Methods: Clinical outcomes in waitlisted transplant candidates managed by our cardio-renal MDT protocol were compared against our standard protocol. Data compared include the transplantation, event, and death rates, cost of cardiac investigations and procedures, and graft, patient survival, and re-hospitalization rates in transplanted patients., Results: 207 patients were studied (81 standard, 126 cardio-renal MDT). Over 2.7 years, the cardio-renal MDT protocol transplanted more patients than the standard group (35% vs 21%; P = .02). The managing cost per patient per year was higher in the standard group (£692 vs £610). This was driven by more echocardiograms and more tests per patient in the standard group (P < .01). There was no difference in adverse events or death. There was no difference in re-hospitalization, graft or patient survival rate in transplanted patients., Conclusions: Our cardio-renal MDT was effective in managing high-risk kidney transplant candidates with greater rates of transplantation and low rates of events at a lower cost., (© 2020 The Authors. Clinical Transplantation published by John Wiley & Sons Ltd.)