Patients with end stage renal failure (ESRF) and lower urinary tract abnormality (LUTA) are often considered high risk for renal transplantation. To examine the degree of risk, we reviewed our experience of 48 patients who received renal transplants in Labafi nejad Hospital between 1985 and 2004. Mean age was 11.5 yr in both patient and control groups. Among the patients, 35% were girls and 65% were boys. Urologic anomalies included posterior urethral valves in 4 cases, ureteral obstruction in 4 cases and neurogenic bladder in 40 cases. Among controls 0.1% had hyper-acute rejection, 59% had acute rejection and 35% had chronic rejection. In patients with LUTA, 8% had hyper-acute rejection, 75% had acute rejection and 39.5% had chronic rejection. However there was no significant difference between these two groups (hyper-acute rejection: Pv=0.11, acute rejection: Pv=0.52, chronic rejection: Pv=0.29). Graft failure was seen in 33% (16/48) of patients. This value was the same in children without LUTA who underwent renal transplantation in our hospital. Mean survival time was 6 years in patients with LUTA, and 7.3 years in control group. This difference was not significant statistically (Pv 0.7). The rate of graft survival in the first year after transplantation was 90%; rates for the third, fifth and seventh years after transplantation were 76%, 65% and 40% respectively in patients with LUTA. In controls, graft survival was 88% in 1 year, 73% in 3 years, 70% in 5 years and 49% in 7 years after transplantation. We concluded graft survival was the same in these two groups.