Kidney transplantation is the most effective method of replacing kidney function, and it significantly improves the quality of life compared to other methods of treating end-stage chronic kidney disease. The kidney of a living or a deceased donor can be transplanted, and before a decision on the surgical procedure is made, the donor and the recipient must undergo extensive processing to determine absolute and relative contraindications. Explantation is performed using a minimally invasive approach, while the kidney is implanted through open surgery, and is placed heterotopically in the pelvis, most often in the iliac fossa. Post-transplant urological complications are ureteral stenosis, urine leakage, vesicoureteral reflux and urolithiasis. The frequency of urolithiasis in the world is less than 1%, making it a rare complication, but recognition and treatment are challenging for doctors. Urolithiasis in transplant recipients is most often presented with hydronephrosis, painless macrohematuria and unexplained fever. The diagnostic methods used to establish the diagnosis are ultrasound, computed tomography, magnetic resonance, scintigraphy and ureteropyelography. If the stone was transferred with the transplant, it is most often treated with ex vivo ureteroscopy or pyelolithotomy immediately after nephrectomy. De novo urolithiasis is treated in the same way as native kidney urolithiasis, but the extraanatomical position of the graft, the ectopia of the ureterovesical junction, the proximity of other anatomical structures and perirenal fibrous tissue represent possible complications in the technical performance. Depending on the size of the stone and the treatment method used, stones are successfully eliminated in 78% to even 100% of cases. Ureterorenoscopy proved to be the least successful, especially with the antegrade approach, while the most successful method is extracorporeal shock wave lithotripsy. Considering that these are immunosuppressed patients, timely diagnosis and treatment are vital to prevent graft loss.