Purpose <p>The purpose of this single center retrospective study is to evaluate the safety and effectiveness of cryoablation for T1 renal cell carcinoma(RCC) in patients who have undergone organ or tissue transplant of any kind.</p> Materials and methods <p>All patients who underwent cryoablation for T1 renal cell carcinoma at a single academic institution were retrospectively reviewed. The patients complications, local recurrence free survival (LRFS), overall recurrence free survival (RFS), and overall survival (OS) were reviewed. Patients were separated into transplant and non-transplant cohorts and compared. Given baseline differences in the cohorts a propensity score matching analysis was performed.</p> Results <p>In total 148 patients with 160 lesions were included, including 19 lesions in transplant and 141 lesions in non-transplant patients. When comparing the transplant and non-transplant cohorts there was no difference in rate of local recurrence (1(1/19, 5.3%) vs. 12(12/141, 8.5%)(<i>p</i> = 1)) or overall recurrence (1(1/19, 5.3%) vs. 15(15/141, 10.6%)(<i>p</i> = 0. 696)). Kaplan-Meier curves did not show any difference in the LRFS (<i>p</i> = 0.452, Hazard ratio (HR):0.56(95% confidence interval (CI):0.12–2.56) or OS (<i>p</i> = 0.430, HR(95%CI):0.7(0.29–1.7), respectively) between transplant and non-transplant patients. However, the RFS was significantly better in transplant as compared to non-transplant patients (HR:0.35(95%CI: 0.14–0.83), <i>p</i> = 0.018). When a propensity score matching analysis was performed there was no significant difference in LRFS (33.3(interquartile range (IQR):12.9–72.4) vs. 35.1(IQR:17.8–84.4) months, <i>p</i> = 0.881), RFS (33.3(IQR:12.9–72.4) vs. 35.1(IQR:17.8–84.4) months, <i>p</i> = 0.881), or OS (33.3(IQR:12.9–72.4) vs. 38.8(IQR:17.8–84.4) months, <i>p</i> = 1).</p> Conclusions <p>Cryoablation of T1 RCC may be as safe and effective in transplant patients as non-transplant patients.</p> Graphical Abstract <p></p>