Purpose: Fibromuscular dysplasia (FMD) is a non-atherosclerotic systemic arterial disease that is not infrequently discovered during kidney donor evaluation (approximately 2-6% of living kidney donors). This can be diagnosed pre-operatively in living donors or intra-operatively/post-operatively in deceased donor allografts. There are no guidelines on renal allografts with FMD. The short and long-term consequences remain uncertain, but it is hypothesised that FMD can cause early graft dysfunction due to renal artery stenosis or dissection. We review the literature on symptomatic renal allografts with FMD and the management techniques. Methodology: A literature review was performed in MedLine, PubMed, and Embase for search terms “fibromuscular dysplasia”, “kidney transplantation” or “renal transplantation”, and “renal artery stenosis”. All relevant articles were included. Results: 19 studies (17 case reports and 2 case reviews) were included and reviewed. Management of FMD in renal allografts were either prophylactically performed or for therapeutic purposes. Prophylactic techniques described include resection of affected segment +/- reconstruction with venous graft or arterial graft. Symptomatic FMD in renal allografts present as graft dysfunction such as hypertensive crisis or rising creatinine. Therapeutic techniques described include open surgical revision and endovascular treatment of renal artery stenosis. Follow up ranged from 1 week to 5 years. Primary outcomes were blood pressure and measured creatinine. Majority of studies showed stable allograft function post intervention, with two studies resulting in transplant nephrectomies. Conclusion: Renal allografts with FMD may have a role in renal transplantation, but clinicians and transplant surgeons must be wary of their potential complications. Both open surgical and endovascular techniques have been described to treat symptomatic FMD or prophylactically treat renal allografts with FMD. Successful treatment has been observed but little is known about long-term outcomes and further studies are warranted.