Gastrointestinal complications are frequent after kidney transplantation, and they may be associated with a high rate of morbidity and mortality. Colonic surgery in kidney transplant recipients is associated with an increased risk of postoperative complications and mortality, together with a potential increased rate of anastomotic leakage. The most frequent non-oncologic indication for colonic surgery is acute diverticulitis with colon perforation, which may affect up to 1% of renal transplant recipients, with a higher incidence in patients with autosomal dominant polycystic kidney disease. In 16% of cases, diverticulosis may progress to acute diverticulitis and the treatment could be challenging. While an aggressive surgical approach is suggested in patients with severe diverticulitis, a non-operative approach could be applied to most patients, with an acceptable rate of recurrence and complications. De novo inflammatory bowel diseases (IBDs) are rare gastrointestinal complications in kidney transplant recipients and may have a more aggressive course than that in general population, requiring a surgical approach in up to half of patients.