Caliceal fistulas are unusual complications of renal transplantation. Segmental renal infarction and distal ureteral obstruction may be contributing factors in their formation. Two cases are reported, the first probably a result of segmental renal infarction from failure to recognize and anastomose an accessory renal artery, the second possibly related to blunt trauma to the area of the graft in an automobile accident and ureteral obstruction resulting from blood clots. Nephrostomy drainage through a healthy area of renal parenchyma was instrumental in the salvage of both kidneys.