We report a case of laparoscopic nephrectomy via the retroperitoneal approach for autosomal dominant polycystic kidney disease after renal transplant. A 54-year-old male patient with end-stage renal failure because of autosomal dominant polycystic kidney disease underwent a living donor renal transplant and right nephrectomy via open surgery through a median abdominal incision 5 years previously. However, the left kidney gradually became enlarged. We performed laparoscopic left nephrectomy via the retroperitoneal approach. After dissecting the renal vessels, we performed cyst puncture and aspiration to decrease the kidney volume. The patient's symptoms improved after operation. Laparoscopic nephrectomy for enlarged kidneys with multiple cysts can be safely performed, and the retroperitoneal approach can be preferred if the patient has a history of abdominal surgery or an enlarged polycystic kidney.