Kidney transplant is the best way of treating ESRD patient, but prolonged and heavy immunosuppressive therapies expose them for other complications one of which is malignancy. The incidence of some of cancers is high as much as 3-5 folds in transplant patients as compared to age matched general population. Transitional cell carcinoma of bladder is also encountered after kidney transplantation although it is not a common tumor after transplantation but reported to be high incidence in analgesic nephropathy and long standing ingestion of well water with high arsenic level. We are reporting a 56 years old Saudi male who had ESRD 15 years ago with the history of schistosomiasis. He had two unrelated kidney transplantations with the difference of ten years. He got hemodialysis in between the transplants. First graft was failed due to CAN after 2 years of transplant. He had second transplant then 2 years ago with the working graft. He has history of recurrent UTI, the evaluation of which reveals thickening of bladder wall along three perigraft masses. Cystoscopy and Biopsy shows highly malignant transitional cell carcinoma of bladder. He is under Cisplatin-based chemotherapy. His follow up MRI shows the regression of primary bladder tumors and the three perinephric masses.