Abstract High-head pump-turbine suffers large centrifugal and hydraulic forces due to large rotational speed and severe pressure pulsations during transient processes, and the strong vibration may increase the risk of runner failure. Load rejection transient process is crucial for pumped-storage hydropower stations, and the evolution laws of the runner dynamic stress during this process need profound research. In this study, the evolution of the runner dynamic stress of a prototype pump-turbine during a load rejection transient process was simulated using the one-dimensional and three-dimensional coupling (1D-3D) method and the fluid-structure interaction (FSI) method. The results of this dynamic transient process were compared to the results of the static working points. It is shown that the rotational speed dominates the mean value of stress while the fluctuating amplitude of stress is dominated by pressure fluctuations, which are larger in the S-shaped region of characteristics. Compared with the static working point solutions, the transient process solutions can better reflect the stress fluctuations and should be used for safety assessment.