We evaluated the outcome of graft in children with lower urinary tract dysfunction and compare it with children without these abnormalities. We reviewed 40 recipients younger than 18 year old who underwent 40 renal transplants. Cases divided in 3 groups. Group I, 20 children without lower urinary tract dysfunction and group II, 8 children with bladder dysfunction but adequate drainage and low intravesical pressure and group III, 12 children with lower urinary tract dysfunction with inadequate drainage and low compliance bladder and high lntravesical pressure. A total of 12 children in group III, underwent bladder augmentation before transplantation, including ureterocystoplasty in 3 cases, enterocystoplasty in 4 cases, autoaugmentation in 1 case, and for one case Mitrofanoff was performed. Kidney transplantation was performed in the classic manner by extra peritoneal access and the ureter was implanted by using extravesical anti reflux procedures. At a mean follow up of 20 months, 6 cases lost their grafts. A total of 5 major surgical complications occurred in 40 transplanted kidneys (12.5%) with a similar incidence in all groups. In groups I, II and III the overall graft survival at 1 year was 100%, 95%, and 87% respectively. The overall graft survival at 3 years was 85%, 75%, and 66.2 % in group I, II, and III respectively. In conclusion, with appropriate treatment, children with severely disordered inferior urinary tract function may undergo renal transplantation with a safe and adequate out come.