Purpose: Failed paediatric en-bloc kidney transplant implanted via the Newcastle technique presenting with compression symptoms and discussing the role of preoperative angioembolization in its management. Methodology: Case report and literature review. Results: 30-year-old female underwent a deceased paediatric en-bloc kidney transplant for lupus nephritis. She sustained graft loss secondary to BK virus nephropathy and returned to haemodialysis. She presented with bothersome lower abdominal discomfort and lower urinary tract symptoms such as increased urinary frequency, urgency, nocturia and incomplete voiding. Cross sectional imaging revealed the hypertrophied graft kidneys causing a significant mass effect compressing urinary bladder shifting it to the left side of her pelvis. To relieve these symptoms and cease immunosuppression, she required a graft nephrectomy. Patient underwent preoperative selective angioembolisation of both graft renal arteries followed by an open graft nephrectomy with a subcapsular approach and en masse stapler ligation of the pedicles. The angioembolisation procedure used gelfoam in the main renal arteries to keep the pedicle supple followed by an Amplatzer plug in the distal third segment of the donor aorta therefore occluding the take off point of the two transplant renal arteries. This led to significant decrement in the size of the en bloc kidneys. Intraoperatively the kidneys were explanted with minimal blood loss. She recovered well and was discharged on post operative day 4. There are no cases reported in literature using preoperative angioembolisation prior to en bloc graft nephrectomy. This technique resulted in reduced intraoperative blood loss, transfusion requirement and post operative stay. Conclusion: Paediatric en bloc kidney transplant graft nephrectomy is technically challenging requiring meticulous surgical planning. Preoperative angioembolisation is technically feasible in this setting reducing potential morbidity.