Introduction: Transplant renal artery stenosis (TRAS) is a significant complication after renal transplantation. Peak systolic velocities (PSV) >200cm/s have been suggested as the cut-off for suspecting significant stenoses which may require further delineation on angiogram. The aim of our study is to explore the utility of PSV in identifying stenoses which will ultimately require endovascular intervention. Methods: A retrospective cohort study was performed using a database of patients collected from a major Australian tertiary hospital including all renal transplant operations in the last 10 years. Data was analysed using receiver operating characteristic (ROC) curves and the J-Youden statistic to determine optimal cut-off points for patients who required endovascular intervention. Outcomes from angioplasty and stenting were analysed. Results: There were 914 patients included on the transplant database with 52 patients suspected of TRAS. Of these, 12 patients required intervention with 3 undergoing angioplasty only and 9 requiring further stenting. Indications included acute kidney injury, steadily declining renal function or worsening stenosis. ROC Curve analysis yielded PSV, serum creatinine and SBP area under the curve of 0.74 (95% CI 0.59-0.89), 0.65 (95% CI 0.48-0.82) and 0.68 (95% CI 0.52-0.84) respectively. Optimal cut-offs for each parameter was 414cm/s (sens 92%, spec 60%, AUC 0.76), 121.5 (sens 83%, spec 47%, AUC 0.65) and 133mmHg (sens 75%, spec 57%, AUC 0.66). Conclusion: Peak systolic velocity >414cm/s has good predictive value in identifying significant TRAS that require angioplasty or stenting with good outcome.