We report a case of renal cell carcinoma arising in bilateral original kidneys after failure of transplant graft function. A 47-year-old man had received a living related renal transplantation on December 10, 1985. He had resumed hemodialysis (HD) therapy because of graft failure on January 8, 1996. Periodic computed tomography (CT), after resumption of HD, revealed multiple cystic change in bilateral original kidneys and a mass in the right kidney. He was referred to our hospital on August 4, 1998 for management of the increased right renal lesion. Abdominal angiography demonstrated a hypervascular and solid mass not only in the right kidney but also in the left kidney. He underwent transperitoneal bilateral nephrectomy. Histopathological examination revealed renal cell carcinoma, bilaterally, with alveolar type and granular cell subtype. He was free of evidence of recurrence and metastasis for 30 months after nephrectomy.