We report a case of renal vein occlusion in a transplant kidney that occurred secondary to extrinsic compression from a large kidney being placed extraperitoneally in a small iliac fossa. Prompt reexploration in the immediate postoperative period resulted in salvage of the graft. The abdominal wall was reconstructed using prosthetic mesh, which decreased the compartmental pressure within the iliac fossa sufficiently to allow the kidney to perfuse and the renal vein to remain patent. The patient was eventually discharged home with a functioning graft and normal flow in the vessels, as demonstrated by duplex Doppler studies.