Transplant renal artery stenosis is an increasingly recognized vascular complication after renal transplant. It can result in posttransplant hypertension and graft dysfunction and eventually in graft loss. Timely diagnosis and appropriate intervention for clinically significant transplant renal artery stenosis can potentially halt or reverse these adverse effects, leading to better outcomes. Duplex ultrasonography is the imaging modality of choice to screen suspected cases. Some patients with transplant renal artery stenosis will require invasive treatment with endovascular intervention or surgery, whereas others can be safely treated with blood pressure control and follow-up. In this review, we aimed to discuss the epidemiology, clinical presentation, pathogenesis, diagnosis, and management of this common posttransplant complication.