To summarize the diagnosis, surgical intervention and postoperative management of patients with urothelial cancer (UC) after renal transplants (RTx). In our retrospective review of 3,370 RTx recipients in our transplant center from 1974 to 2012, all recipients underwent routine checkups and follow-up. Imaging was performed in all patients suspected of having malignancies, and the histological cell type of the specimen slices was reappraised by pathologists. The data of all recipients with malignancies were retrospectively reviewed to determine clinical characteristics after RTx. A total of 169 patients of the cohort of 3,370 had malignancies after RTx. Of 180 tumors, 106 tumors were confirmed as UC. Fifty-two patients had taken drugs containing aristolochic acid. The median time to neoplasia after RTx in the group taking aristolochic acid (30 months) was significantly less than in those not taking aristolochic acid (60.3 months). We recommended surgical intervention for RTx recipients with UC, transurethral resection of bladder tumors for patients with solitary or concomitant superficial UC, and radical cystectomy for high-risk bladder UC. We performed simultaneous bilateral or unilateral nephroureterectomy in patients with upper urinary tract UC. Our results suggest that UC is the predominant tumor in Chinese RTx recipients and that regular urinalysis and imaging are needed in all recipients after RTx, especially women with a history of taking aristolochic acid. Surgical interventions did not increase the risk beyond that in UC patients without RTx.