Purpose: Presenting an uncommon stent related complication in kidney transplant and challenges in its management. Methodology: Case report and literature review. Results: A 54-year-old gentleman received a deceased donor kidney transplant. Ureteric anastomosis was a standard Lich Gregoire technique over a 4.7Fr 22cm double J ureteral stent. During planned flexible cystoscopy and stent removal on Day 30, the upper end of the stent could not be removed from the neoureterovesicostomy orifice. The stent fractured on repeated attempts at removal with traction. Patient developed anuria post procedure. Non contrast CT showed knotted upper end of stent in the distal ureter. He was taken for an emergency stent removal under general anaesthesia with involvement of our urology colleagues. Attempt to pass a guide wire through the stent to uncoil upper end failed. Retrograde ureteroscopy was not successful due to the difficult angle of the neo-orifice. A guide wire eventually was passed with difficulty by the side of the stent and the stent removed. A new stent was placed over the guidewire. One day following this procedure, a urine leak was confirmed on Mag 3-SPECT scan necessitating a return to theatre. Intraoperatively, there was a perforation in the mid transplant ureter likely because of repeated attempts at placing a retrograde guidewire. There are roughly 40 cases reported in urology literature and fewer than 5 cases reported in the renal transplant. A longer stent is a predisposition for knotting. Conclusion: Knotted ureteral stent in a transplant kidney is an extremely rare complication which is difficult to manage. Our case highlights that removal with excessive traction should be avoided as it can lead to further complications. Retrograde transplant ureteral interrogation is challenging given its anterior superior position of the neo-orifice and surgical revision might need to be considered in the first instance.