Systemic treatment of advanced renal cell carcinoma (RCC) after kidney transplantation requires balancing cancer control against allograft injury and immunosuppression. We searched PubMed, Ovid Embase, Scopus, Web of Science, and ClinicalTrials.gov in April 2026, with reruns on 13 August and 19 October 2026. We separated RCC-specific transplant reports from mixed-cancer transplant and non-transplant studies. Direct evidence comprised mainly case reports and retro-spective cohorts with incomplete outcomes and possible overlap. No prospective kidney-transplant-specific RCC study was identified. Vascular endothelial growth factor receptor–targeted tyrosine kinase inhibitors achieved tumor control in selected reports, but renal toxicity and interactions limited safety conclusions. Indications for mechanistic target of rapamycin in-hibitors (RCC treatment or immunosuppression) were often unclear. Concurrent therapies com-plicated response attribution. Immune checkpoint inhibitor outcomes ranged from tumor control with preserved graft function to rejection, irreversible graft loss, dialysis, graft intolerance, or nephrectomy. An unvalidated multidisciplinary framework integrates tumor site and lineage, histology, performance status, immunosuppression, and patient priorities. It distinguishes func-tioning or failing grafts, irreversibly failed retained grafts, and absence of allografts, states that change treatment trade-offs and outcome interpretation. Comparative evidence establishes nei-ther a preferred RCC sequence nor a graft-protective immunosuppressive regimen. Prospective studies should prioritize paired, state-specific cancer and transplant outcomes.