The incidence of transplant renal artery stenosis (TRAS) in renal allografts varies from 1% to 23%, we sought to examine its incidence, and effect of treatment options on outcome and long-term effect on hypertension and renal function. Within a 7-year time period we evaluated 12 patients 8 males and 4 females, average age 40.77+/-10.97 (24-56) years. who had undergone renal transplantation and subsequently were diagnosed with refractory hypertension and transplant dysfunction suggestive for possible transplant renal artery stenosis. Color Doppler ultrasonography and CT angiography and in some cases conventional angiography was performed. After exclusion of 3 technical failures, 9 PTRAs were followed at 1 month, 6 months and 1-3 years after PTRA. Hypertension improvement was defined as mean arterial pressure (MAP) decrease of at least 15% from the pre-PTRA value. Graft function was evaluated by serum creatinine (Scr) levels, and the improvement was defined as a 20% change. PTRA technical success was 66%. In 9 kidney recipients at the end of fallow up , blood pressure improved in 65.2% of patients (MAP decreased from 118+/-18.54 to 106+/-14.15 mmHg), but no patient remained normotensive and medication free. Graft function improved in 66% of patients and was stabilized in 33.3% of them (average Scr before PTRA: 2.6+/-0.0.46, after PTRA: 1.9+/-0.35mg/dl). There was no complication and mortality. In conclusion PTRA in kidney transplant recipients are effective mainly in preserving graft function.