Chronic immune suppression is a risk for the development of post-transplantation lymphoproliferative disorders, which are frequently caused by a B-cell dyscrasia. We report a unique primary presentation of the rare angiotropic lymphoma in a kidney allograft, 18 years after transplantation. The diagnosis was made by a percutaneous allograft biopsy specimen when the recipient presented with renal dysfunction and intermittent hematuria. Immunostaining of the biopsy specimen revealed a T-cell lineage of the neoplastic cells rather than the more common B-cell source. At the time of biopsy, there was no evidence of systemic dissemination of lymphoma. The intragraft lymphoma resolved completely after chemotherapy, but the patient died 6 months later as a result of an intracerebral hemorrhage. At autopsy, intravascular lymphoma was only found in the cerebral vessels. To the authors' knowledge, this is the first report of angiotropic T-cell lymphoma in a kidney allograft. A description of the clinical, pathologic, and immunohistochemical features of this case is provided, as well as reviews of previous reports of renal angiotropic lymphoma and post-transplantation T-cell lymphomas.