Chronic renal failure occurs in 250 of every one million peoples each year worldwide and renal transplantation is the treatment of choice for end-stage renal disease (ESRD). Renal stone is one of the most important causes of ESRD because of its role in infection (UTI) and obstruction. The present study was performed to evaluate the effect of renal stone in outcome of transplantation. Since Nov.1988 till Nov. 2003, 1000 kidney transplantations were performed in Shiraz (Southern Iran) Organ Transplant Center. 39 patients have had renal stones, of whom 12 had undergone nephrectomy. 50 cases without stones were selected as control. All patients in three groups underwent the same procedure and post-op care in the same center. Post-op complications like hematuria, infection, proteinuria, and graft and patient survival was calculated in the three groups. Incidence of renal stone in native kidney was 4%. Hematuria, infection, and proteinuria occurred more frequently among cases without nephrectomy. Graft loss occurred in 8.3% (versus 11.1%) of patients with pre-transplant nephrectomy. Some authors suggest pre-transplant nephrectomy in renal stone cases and believe that stone removal without nephrectomy is not enough. In past, bilateral nephrectomy had been done to increase graft survival, but at present, this procedure is done rarely. In our study, nephrectomy has reduced some post-op complications; however, risk-benefit must be done for such operation, because of risks of such major and invasive surgery.