Introduction: Pharmacological stress testing is routinely performed for cardiovascular assessment in kidney transplant candidates due to perceived poor exercise capacity in such patients. Although exercise stress testing is feasible, the prognostic utility of exercise capacity in this patient population has not been investigated. Hypothesis: We hypothesize that exercise capacity predicts long term cardiovascular risk in kidney transplant candidates undergoing exercise stress echocardiography (ESE) for pre-transplant cardiovascular assessment. Methods: We prospectively evaluated 898 patients with stage 4/5 chronic kidney disease from 2013 to 2020 who performed symptom limited treadmill ESE. Exercise capacity was calculated as age and sex predicted metabolic equivalents (METs). The primary outcome was incident major adverse cardiovascular events (MACE), defined as a composite of cardiac death, non-fatal myocardial infarction and stroke. Cox proportional hazard multivariable modelling was performed to identify predictors of MACE, with transplantation treated as a time-varying covariate. Results: There were 106 MACE. During follow up, 525 (58%) received a kidney transplant. Achievement of predicted METs (hazard ratio (HR) 0.49, 95% confidence interval (CI) 0.29-0.82, p=0.007) and transplantation (HR 0.52, 95% CI 0.30-0.91, p=0.02) were independently associated with less incident MACE. Patients who achieved predicted METs had similar rates of MACE irrespective of subsequent transplantation ( Figure 1 , HR 0.78, 95% CI 0.32-1.92, p=0.59). Patients who achieved predicted METs and were not transplanted had similar outcomes to those that did not achieve predicted METs and received a kidney transplant ( Figure 1 , HR 0.97, 95% CI 0.42-2.25, p=0.95). Conclusions: Exercise capacity is associated with reduced MACE in kidney transplant candidates. Achievement of predicted METs confers excellent prognosis independent of subsequent transplantation.