Introduction. Malignancy is a well-known complication after renal transplantation. We studied the influence of cancer on patient survival in the Dutch renal transplant population in a nested case-controlled analysis. Methods. Between March 1966 and May 2008, 15,227 renal transplantations in 12,805 recipients were registered in the Netherlands Organ Transplant Registry database. Total follow-up was 89,651 person years. We performed an analysis of patient and graft survival both from the day of transplantation and the diagnosis of cancer in recipients with invasive cancer. Recipients without invasive cancer, matched for gender, age, and year of transplantation, served as a control group. For the survival analysis after the diagnosis of cancer, the matched control group consisted of patients with a functioning graft at the moment the index patient was diagnosed with cancer. Results. Cancer had been registered in 908 (7.1%) patients, 630 (69%) of them died with functioning kidney, 510 (81%) because of their malignancy (at 8.2 years after transplantation, median). The median patient survival after transplantation was 11.9 vs. 16.8 years in the study and control group, respectively (P<0.001). The median patient and graft survival after the diagnosis of cancer was 2.1 vs. 8.3 (P<0.001) and 25 vs. 22.4 (P<0.001) years in the study and control group, respectively. Conclusion. Mortality because of cancer is observed at a significantly later time after transplantation compared with mortality because of the other main lethal complications. It significantly affects life expectancy and carries a poor prognosis with a limited survival after diagnosis.