OBJECTIVE To evaluate the role and the effectiveness of interventional radiology in the treatment of renal transplant complications. METHODS From 1996 to 2004 a total of 288 kidney transplants from cadavers were performed in our Institute. The kidney was always collocated in iliac fossa by creating a vascular anastomosis with the external iliac artery and vein; in all cases the ureter was implanted into the recipient bladder. During the follow-up, 34 complications were observed. Twenty-seven complications in 25 patients (20 males and 5 females; age 35-65 years) were treated by a radiologic procedure: 9 renal artery stenosis and 1 native external iliac artery stenosis (by PTA), 5 ureteral obstructions (by nephrostomy and ureteral stenting), 8 ureteral leaks (by nephrostomy, in 2 cases associated to ureteral stenting) and 4 limphoceles (by percutaneous ultrasound-guided catheter drainage). RESULTS Primary technical success was obtained in 20/27 cases (74%). Success was obtained with a second interventional procedure in 3/27 cases, 2 limphoceles and 1 ureteral fistula (secondary technical success: 85.2%), with a clinical final success in 23/27 cases (85.2%). We observed a peri-procedural complication rate of 3.7% (1 renal artery post-PTA dissection during a restenosis treatment). Four cases (1 renal arterial post-PTA dissection, 1 ureteral obstruction, 1 ureteral leak and 1 limphocele) needed a surgical correction (14.8%). CONCLUSIONS Interventional radiology is the first therapeutic approach to treat renal transplant complications. It shows good technical and clinical results and a low complication rate. Surgery had to be considered only if minimally invasive procedures are infeasible or ineffective.